What Do Physicians Think of Somatoform Disorders?

Abstract

Although somatoform presentations are common, there is considerable confusion regarding the diagnostic terminology and a reluctance to use these diagnostic labels. The aim of this study was to elicit the views of physicians who see these patients. Four small group discussions were held in San Diego and Edinburgh. Psychiatrists from very different practice settings attended these groups (child psychiatrists, forensic psychiatrists, psychopharmacologists, consultation psychiatrists, psychotherapists). Non-psychiatrist attendees included neurologists, pediatricians, internists, and gastroenterologists. Using themes identified from the groups, an anonymous internet poll was designed and physicians from a variety of professional organizations were invited to respond to an anonymous poll. Three hundred thirty-two physicians responded to the poll. Two-thirds were psychiatrists; two-thirds were from the United States. While, in general, physicians reported that somatoform patients were relatively rare in their practices (i.e., 0-2%), some physicians reported high prevalence of these patients (i.e., >20%). Over 30% of the physicians considered the diagnostic guidelines for pain disorder and somatoform disorder not otherwise specified as "unclear." Similar numbers of doctors regarded these particular diagnoses as "not useful." Physicians were uniform in their opinion that patients disapproved of such diagnostic labels. Over 90% of respondents felt that there was an overlap between somatization disorder, pain disorder, hypochondriasis, and somatoform disorder not otherwise specified. These observations imply a need for considerable restructuring of these diagnoses in DSM-5.