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Chapter 36. Somatization Disorder and Undifferentiated Somatoform Disorder

Mehmet E. Dokucu, M.D., Ph.D.; C. Robert Cloninger, M.D.
DOI: 10.1176/appi.books.9781585622986.259880

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Excerpt

Somatization disorder is among the best-validated disorders in psychiatry, but no specific treatment is known for it. Moreover, the disorder leads to frequent and high-cost use of health care services and often frustrates physicians and patients alike, resulting in therapeutic nihilism in the minds of many people. The benefits of single treatment approaches (pharmacological or psychosocial) reported by many controlled studies have been modest, and the clinical significance of the reported benefits is not very impressive. It is therefore difficult to prescribe a precise and strictly evidence-based treatment for somatization disorder and its less severe versions—undifferentiated somatoform disorder and somatoform disorder not otherwise specified. Nevertheless, our clinical experience and reports by others indicate it is possible to improve the lives and functioning of patients greatly by following an individually tailored and multifaceted management approach that incorporates biological, psychosocial, and spiritual approaches to well-being. This means that for every individual patient, a practitioner should consider each of the therapeutic modalities discussed here according to its suitability to the patient's broad clinical picture, the patient's specific needs, and its availability in the patient's community. For instance, cognitive-behavioral therapy (CBT) groups that are modified for somatization may not be available everywhere, or the clinician may not feel qualified to offer it in his or her office. Some patients may not be interested in or adherent to exercise and/or medications. Thus, our general approach can be summarized as being eclectic and customized to individual patients. We believe that because many of the treatments studied show mild to moderate effect sizes, combining different modalities would work additively or synergistically, improving functional outcome much more than a single modality. In this chapter, when we do not provide specific references, this indicates that the material is based on our clinical experience.

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