What is the treatment for psychosomatic (psychosomatic) disorder?

Treatment for Psychosomatic Disorder

The treatment for psychosomatic disorder should include a combination of psychotherapy (particularly cognitive behavioral therapy, hypnosis, or suggestion therapy) as the primary intervention, with pain modulators or antidepressants reserved for refractory cases. 1

Diagnostic Considerations

• Psychosomatic disorder (now termed "somatic symptom disorder" in DSM-5) involves physical symptoms that cause significant distress without adequate medical explanation 1
• Diagnosis requires ruling out medical causes through comprehensive evaluation before attributing symptoms to psychosomatic origins 1
• Key diagnostic criteria include:
  • One or more distressing somatic symptoms disrupting daily life
  • Excessive thoughts, feelings, or behaviors related to these symptoms
  • Persistent symptomatic state (typically >6 months) 1

First-Line Treatment Approaches

Non-Pharmacological Interventions

• Hypnosis or suggestion therapy is recommended as first-line treatment, particularly effective in children 1
• Cognitive behavioral therapy helps patients understand the connection between psychological stress and physical symptoms 1, 2
• Reassurance and counseling should be provided to both patients and families 1
• Psychological referral is indicated for comprehensive evaluation and treatment planning 1, 3

Communication Strategies

• Emphasize collaboration between patient, family, and all caregivers 1
• Identify common goals focused on improving functioning in addition to symptom resolution 1
• Provide reassurance that symptoms are being taken seriously, even without identifiable organic cause 1
• Educate patients about the mind-body connection in symptom development 2

Second-Line Treatment Approaches

Pharmacological Options

• Pain modulators such as tricyclic antidepressants and selective serotonin reuptake inhibitors can be used for refractory cases 1
• Medication should target specific symptoms (e.g., pain, anxiety) rather than the overall condition 1, 2
• Start with low doses and titrate slowly to minimize side effects 1

Complementary Approaches

• Relaxation training has been shown to reduce symptom scores in some patients 1
• Abdominal breathing exercises can improve quality of life scores 1
• Meditative states may help manage the neuropsychobiological stress response 2

Special Considerations

Children and Adolescents

• Prevalence of psychosomatic complaints in children is 10-25% 3
• Common pediatric presentations include abdominal pain, headaches, chest pain, fatigue, and limb pain 3
• Family involvement is crucial for successful treatment in pediatric cases 1, 3

Refractory Cases

• For persistent symptoms despite initial treatment, consider:
  • Reevaluation for missed medical conditions 1
  • Intensification of psychotherapy 1, 2
  • Trial of different medication classes 1
  • Multidisciplinary approach involving psychiatry, psychology, and relevant medical specialties 2

Common Pitfalls to Avoid

• Attributing symptoms to psychiatric illness without thorough investigation of medical causes 1, 3
• Using stigmatizing terminology like "psychogenic" (instead use "somatic symptom disorder") 1
• Dismissing symptoms as "not real" or "all in your head" 1
• Excessive medical testing that reinforces illness behavior 1, 4
• Focusing solely on symptom elimination rather than functional improvement 1, 4

By implementing this treatment approach, clinicians can effectively address both the psychological factors and physical symptoms experienced by patients with psychosomatic disorders, improving their overall quality of life and functioning.