General Management of Somatization

  • Kyung Bong Koh


Cognitive behavioral therapy (CBT) is known to be effective in patients with somatic symptom and related disorders. History taking, physical examination, and investigations can be used to confirm or refute the patients’ beliefs. Mindfulness-based cognitive therapy (MBCT) can help improve mental functioning (e.g., vitality and social functioning) in somatizing patients and change unhelpful behavioral patterns and increase self-care. In particular, MBCT can be considered a meaningful therapy for patients with somatizing disorders because it encourages them more willing to receive mental health care. Psychiatric consultation can be used as therapeutic strategy. In addition, psychopharmacotherapy is essential for management of somatization. Considering the limitations of time for physicians, an integrated brief therapy is recommended for such patients. This form of therapy should be multimodal by combining psychiatric consultation, CBT, and psychopharmacotherapy.


Cognitive behavioral therapy (CBT) Mindfulness-based cognitive therapy (MBCT) Psychiatric consultation Psychopharmacotherapy Integrated brief therapy 


  1. 1.
    Sharma MP, Manjula M. Behavioral and psychological management of somatic symptom disorders: an overview. Int Rev Psychiatry. 2013;25:116–24.CrossRefGoogle Scholar
  2. 2.
    Patel V, Sumathipala A. Psychological approaches to somatization in developing countries. Adv Psychiatry Treat. 2006;12:54–62.CrossRefGoogle Scholar
  3. 3.
    Sharpe M, Peveler R, Mayou R. The psychological treatment of patients with functional somatic symptoms: a practical guide. J Psychosom Res. 1992;36:515–29.CrossRefGoogle Scholar
  4. 4.
    Bass C, Benjamin S. The management of chronic somatization. Brit J Psychiatry. 1993;162:472–80.CrossRefGoogle Scholar
  5. 5.
    Bass C, Peveler R, House A. Somatoform disorder: severe psychiatric illnesses neglected by psychiatrists. Brit J Psychiatry. 2001;179:11–4.CrossRefGoogle Scholar
  6. 6.
    Fink P, Rosenthal M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry. 2008;21:182–8.CrossRefGoogle Scholar
  7. 7.
    Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12:34–43.CrossRefGoogle Scholar
  8. 8.
    Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69:881–8.CrossRefGoogle Scholar
  9. 9.
    Price JR. Managing physical symptoms: the clinical assessment as treatment. J Psychosom Res. 2000;48:1–10.CrossRefGoogle Scholar
  10. 10.
    Salkovskis PM. Somatic problems. In: Hawton K, Salkovskis PM, Kirk J, et al., editors. Cognitive behavior therapy for psychiatric problems. A practical guide. Oxford: Oxford University Press; 1989.Google Scholar
  11. 11.
    Thomas KB. General practice consultations: is there any point in being positive? BMJ. 1987;294:1200–2.CrossRefGoogle Scholar
  12. 12.
    Fitzpatrick RM, Hopkins A. Referrals to neurologists for headaches not due to structural disease. J Neurol Neurosurg Psychiatry. 1981;44:1061–7.CrossRefGoogle Scholar
  13. 13.
    van Dulmen A, Fennis JF, Mokkink HG, et al. Doctor-dependent changes in complaint-related cognitions and anxiety during medical consultations in functional abdominal complaints. Psychol Med. 1995;25:1011–8.CrossRefGoogle Scholar
  14. 14.
    Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31:1032–40.CrossRefGoogle Scholar
  15. 15.
    Manicavasgar V, Parker G, Perich T. Mindfulness-based cognitive therapy vs cognitive behavior therapy as a treatment for non-melancholic depression. J Affect Disord. 2011;130:138–44.CrossRefGoogle Scholar
  16. 16.
    Hofmann SG, Sawyer AT, Fang A. The empirical status of the new wave of cognitive behavioral therapy. Psychiatr Clin N Am. 2010;33:701–10.CrossRefGoogle Scholar
  17. 17.
    Felder JN, Dimidjian S, Segal Z. Collaboration in mindfulness-based cognitive therapy. J Clin Psychol. 2012;68:179–86.CrossRefGoogle Scholar
  18. 18.
    Lakhan SE, Schhofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013;8:e71834.CrossRefGoogle Scholar
  19. 19.
    van Ravesteijn H, Lucassen P, Bor H, et al. Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: a randomized controlled trial. Psychother Psychosom. 2013;82:299–310.CrossRefGoogle Scholar
  20. 20.
    van Ravesteijn H, Suijkerbuijk YB, Langbroek JA, et al. Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: process of change. J Psychosom Res. 2014;77:27–33.CrossRefGoogle Scholar
  21. 21.
    van Ravesteijn H. Mindfulness-based cognitive therapy for patients with somatoform disorders. Tijdschr Psychiatry. 2016;58:198–206.Google Scholar
  22. 22.
    Smith GR Jr. Effectiveness of treatment for somatoform disorder patients. Psychiatry Med. 1991;9:545–58.Google Scholar
  23. 23.
    van der Feltz-Cornelis CM, van Oppen P, Ader HJ, et al. Randomized controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother Psychosom. 2006;75:282–9.CrossRefGoogle Scholar
  24. 24.
    Strain JJ. Consultation-liaison psychiatry. In: Sadock BJ, Sadock VA, editors. Comprehensive textbook of psychiatry. 7th ed. Baltimore: Lippincott Williams & Wilkins; 2000.Google Scholar
  25. 25.
    Somashekar B, Jainer A, Wuntakal B. Psychopharmacotherapy of somatic symptoms disorders. Int Rev Psychiatry. 2013;25:107–15.CrossRefGoogle Scholar
  26. 26.
    Linch ME. Antidepressants as analgesics: a review of randomized controlled trials. J Psychiatry Neurosci. 2001;26:30–6.Google Scholar
  27. 27.
    Sussman N. SNRIs versus SSRIs: mechanisms of action in treating depressions and painful physical symptoms. Primary Care Companion J Clin Psychiatry. 2003;5:19–26.CrossRefGoogle Scholar
  28. 28.
    Fishbain DA, Cutler RB, Rosomoff HL. Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis. Psychosom Med. 1998;60:503–9.CrossRefGoogle Scholar
  29. 29.
    Noyes R Jr, Holt CS, Kathol RG. Somatization: diagnosis and management. Arch Fam Med. 1995;4:790–5.CrossRefGoogle Scholar
  30. 30.
    Morriss R, Gask L, Ronalds C, et al. Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners. Br J Gen Pract. 1999;49:262–7.Google Scholar
  31. 31.
    Morriss RK, Gask L. Treatment of patients with somatized mental disorder: effects of reattribution training on outcomes under the direct control of the family doctor. Psychosomatics. 2002;43:394–9.CrossRefGoogle Scholar
  32. 32.
    Gask L, Goldberg D, Porter R, et al. The treatment of somatization: evaluation of a teaching package with general practice trainees. J Psychosom Res. 1989;33:697–703.CrossRefGoogle Scholar
  33. 33.
    Rosendal M, Olesen F, Fink P, et al. A randomized controlled trial of brief training in the assessment and treatment of somatization in primary care: effects on patient outcome. Gen Hosp Psychiatry. 2007;29:364–73.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Kyung Bong Koh
    • 1
  1. 1.Department of PsychiatryYonsei University College of MedicineSeoulKorea

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