Clinical Practice Guideline
Non-Specific, Functional, and Somatoform Bodily Complaints
; ; ; ; ;
Background: 4–10% of the general population and 20% of primary care patients have what are called “non-specific, functional, and somatoform bodily complaints.” These often take a chronic course, markedly impair the sufferers’ quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician’s part.
Methods: The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. They analyzed more than 4000 publications retrieved by a systematic literature search and held two online Delphi rounds and three consensus conferences.
Results: Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. A strong consensus was reached on most subjects. In the new guideline, it is recommended that physicians should establish a therapeutic alliance with the patient, adopt a symptom/coping-oriented attitude, and avoid stigmatizing comments. A biopsychosocial diagnostic evaluation, combined with sensitive discussion of signs of psychosocial stress, enables the early recognition of problems of this type, as well as of comorbid conditions, while lowering the risk of iatrogenic somatization. For mild, uncomplicated courses, the establishment of a biopsychosocial explanatory model and physical/social activation are recommended. More severe, complicated courses call for collaborative, coordinated management, including regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse), graded activation, and psychotherapy; the latter may involve cognitive behavioral therapy or a psychodynamic-interpersonal or hypnotherapeutic/imaginative approach. The comprehensive treatment plan may be multimodal, potentially including body-oriented/non-verbal therapies, relaxation training, and time-limited pharmacotherapy.
Conclusion: A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient’s active cooperation and the collaboration of all treating health professionals under the overall management of the patient’s primary-care physician.
When the S2e guideline “Somatoform disorders” (1) expired, the German College of Psychosomatic Medicine (DKPM, Deutsches Kollegium für Psychosomatische Medizin) and the German Society of Psychosomatic Medicine and Medical Psychotherapy (DGPM, Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie) determined to rework it comprehensively in an interdisciplinary way for the new edition. Under the coordination of these bodies, from 2008 to 2012, representatives of 28 medical and psychological specialist societies, the German Association for the Support of Self Help Groups (patient representative), and the Association of Scientific Medical Societies in Germany (AWMF, Arbeitsgemeinschaft medizinischer Fachgesellschaften) (eBox 1) developed the new S3 guideline “Management of patients with non-specific, functional, and somatoform bodily complaints” (NFS), of which the present article is the official short version (2–4).
The guideline group included members from all areas of care and was balanced in terms of gender and seniority. At the inaugural meeting, key questions on all clinically relevant themes were formulated and divided up between nine working groups. Building on the 2002 S2e guideline, a seven-member steering group (eBox 1) carried out a systematic literature search of publications dating from 1 January 2000 to 1 January 2009 (for search terms see eBox 2), which was added to and brought up to date by the working groups up to May 2011 (3). After assessment of inclusion and exclusion criteria (eBox 3) and the quality and relevance of the studies (e1) (eTable 1), 761 publications were included for the guideline (Figure 1). The working groups analyzed the literature, evaluated the evidence levels (ELs) (e2) (eTable 2), and developed 148 recommendations, statements, and source texts. For the most important forms of therapy, examples of numbers needed to treat (NNTs) were calculated as a statistical measure of efficacy (Table 1). The guideline was modified in two online Delphi procedures and three consensus conferences, and finalized by consensus, in most cases strong consensus (e3) (eTable 3). The corresponding recommendation grades (RGs) were based on the evidence levels, but could be raised or lowered during the consensus procedure (e4) (eFigure). Recommendations regarded by the guideline group as representing a standard despite a lack of evidence were marked as “clinical consensus points” (CCPs) (e5). The guideline version passed by consensus was posted on the Internet in February 2012 for 4 weeks for public comment. It was reviewed by three external experts (eBox 1), approved by the participating medical societies and associations, and adopted by the AWMF on 15 April 2012 (register no. 051–001). It is valid for 5 years.
Terms and objectives
The plethora of terminology (e6) is a hindrance to care and to research (e7). With the aim of achieving an interdisciplinary perspective, the triple term “non-specific, functional, and somatoform bodily complaints” takes up the parallel classification of functional somatic syndromes (FSS) (somatic medicine) and somatoform disorders (psychosocial medicine), and complements the general medical perspective of non-specific bodily complaints (eBox 4). The guideline is concerned with what these disorders of adults have in common (5, 6, e8, e9). Its aim is to provide practical, interdisciplinary recommendations for all levels of care, to promote a biopsychosocial understanding of health and illness, to optimize early diagnosis, prevention, and treatment, to improve the quality of life and ability to function of those affected, and to reduce undertreatment and erroneous treatment.
Characterization of the disorder
The main symptoms of NFS are pain in various locations, impaired organ functions (gastrointestinal, cardiovascular, respiratory, urogenital), including autonomic complaints, and exhaustion/fatigue (7). These are often accompanied by illness anxiety. If this anxiety dominates, a hypochondriac disorder is present (e10).
Multifactorial disorder model
Current etiopathogenetic models assume complex interactions between psychosocial factors, biological factors, iatrogenic factors or factors related to the medical system, and sociocultural factors, which can lead to neurobiological changes, and act together in disposition, triggering and maintenance of the complaints (7, 8, e11). A health system that focuses more on repair and care than on self-responsibility and prevention, and provides counterproductive financial incentives to illness-related behavior and technical measures rather than to healthy behavior, achievement through talking to the patient, and the avoidance of unnecessary treatment, has the effect of maintaining complaints (7, e11–e13). The iatrogenic chronification factors to be avoided (e14–e21) (CCP) are shown in Box 1.
Epidemiology, co-morbidity, and health care utilization behavior
NFS affect 4% to 10% of the population (2, 4, e22) and 20% of primary care patients (9, 10) (EL 1b), and are reported more frequently by women in all age groups (♀:♂ = 1.5–3:1) (e23, e24) (EL 2b). In specialized settings, such as specialist somatic medical outpatient units or practices, a percentage up to 50% may be assumed (2, 4, e25). In the general population, 10% of those affected with an FSS also fulfill the criteria of one or more other FSSs; in clinical populations this overlap may be as much as 50% (e8, e9, e26) (EL 2a). In both clinical and population-based samples, NFS show a co-morbidity that increases with the severity of the NFS, including depressive, anxiety (11, e27, e28), and post-traumatic stress disorders (e29) as well as addiction disorders (medications, alcohol) (e30, e31). In severe cases (full-blown somatization disorder F45.0) there are often co-morbid personality disorders (e32, e33) (EL 2a). A majority show high, dysfunctional use of the health care system, especially in cases of psychological co-morbidity (9, e34) (EL 2b). The result is high direct (multiple diagnoses, overdiagnosis, inappropriate treatment) and indirect health costs (loss of productivity, long-term inability to work, early retirement) (13, e35). Also in older patients, NFS parts of the complaints should be considered, even if the differential diagnosis is more complex and uncertain because of multimorbidity and multimedication. (14, e36) (EL 2a, RG B).
Course and prognosis
Life expectancy for patients with NFS is presumably normal (e37, e38), but quality of life is more impaired than with somatic diseases (e39) (EL 2b). Suicide risk, especially among those in chronic pain, is greater than in the general population (e40, e41). In patients with fibromyalgia, the standardized mortality ratio for suicide was between 3.3 (95% confidence interval [95% CI] 2.2–5.1) (Danish retrospective cohort study, n = 1269 women [e38]) and 10.5 (95% CI 4.5–20.7) (US retrospective case control study, n = 8186 [e37]).
Irrespective of clinical setting, a less severe course with improvement of functioning and quality of life is seen in 50% to 75% of those affected, and a more severe course (usually marked functional/somatoform disorders, with deterioration of functioning and quality of life is seen in 10% to 30% (15) (EL 1b).
Principles and preconditions of diagnosis and treatment
Attitude and physician–patient relationship
Since the physician–patient relationship is often felt to be difficult on both sides (e42–e45), building up a sound working alliance on a partnership basis is of central importance (7, e46–e48). An active, supportive and biopsychosocial attitude (“as well/as attitude”) is recommended, focusing on symptoms and on coping with them. It is characterized by situational consistency; that is the right balance between reticence and authenticity (“I'm not going to say everything that would be authentic, but what I do say should be authentic”) (e52) (RB B).
First, the physician should allow the patient to describe the complaints spontaneously and explicitly (“accepting the complaint”) (e53) (EL 4, EG B), signaling attention, interest, and acceptance in both verbal and nonverbal ways (“active listening”) (EL 4, EG B). Psychosocial themes should be handled casually and indirectly rather than by confronting them, e.g., by accompanying the patient's report switching to and fro between hinting at psychosocial stressors and returning to the complaints description (“tangential conversation”) (e51). Clues to psychosocial problems and needs shall be picked up empathetically and spoken of as meaningful (e54) (EL 1b, RG A). In constructing the contextual interdependencies, phrases from the vernacular can help (“Is something making you heavy hearted?”) (EL 5, RG 0). The patient should be offered to make a joint decision together with the physician once enough information has been given (“shared decision making”) (e55) (EL 2b, RG A).
Simultaneous biopsychosocial diagnostic assessment
For early diagnosis of NFS, stepped simultaneous diagnostic assessment of both somatic and psychosocial conditioning factors should be carried out. If necessary further medical and/or psychotherapeutic specialists should be consulted (e56–e58) (EL 1b, RG A) (Figure 2). For patients with a chronic course, the first thing is to take stock of the results of previous diagnostic and therapeutic procedures (EL 5, RG 0). Waiting for the exclusion of somatic disease despite the presence of psychosocial stressors is contraindicated.
Biopsychosocial history taking
First, the bodily complaints should be recorded precisely (nature, location, number, frequency, duration, intensity) (e53) (EL 3b, RG B). Because accompanying complaints are often not reported spontaneously, history taking should be extended beyond the main symptoms, e.g., by systematic questioning about the different organ systems (2, 4) (EL 2b, RG A). The number of symptoms is an important predictor of the presence of NFS and of an unfavorable course (15) (EL 1b). For all bodily complaints, everyday functioning and psychological state should be assessed even at the first consultation (e59) (EL 2b, RG B). The patient’s subjective theory of the illness and illness/health behavior should be explored, including, if there are cues about psychosocial stressors or functional impairment, the context of the complaints (family, social network, work, biographical stressors, and resources) (CCP).
Somatic diagnostic investigations
Basic organic diagnostic investigation including physical examination is always necessary. Depending on the pattern of symptoms, specialist diagnostic procedures may also be required (e58) (EL 5, RG B). In the absence of “red flags” and so long as any dangerous illness appears unlikely, a “watchful waiting” approach is recommended, which will not increase the patient’s anxiety (e60) (EL 1b, RG B). Any tests should be discussed with the patient before and after they are carried out in a “de-catastrophizing” way (“normal results expected”) and the reasons for doing them clearly explained (transparency) (e61). A reasonable endpoint for the somatic diagnostic pathway should be agreed and adhered to (EL 1b, RG A).
Characteristics of more severe cases (“yellow flags”) and red flags for more severe, complicated courses including suicidality should be repeatedly evaluated (7, e62, e63) (EL 2b, RG B). Some protective factors (“green flags”) presumably have a favorable effect on the prognosis (e64) (EL 4) and should be recorded and supported (RG B) (Table 2).
Basic treatment in primary care and specialist somatic medicine
The basis of treatment should be “Basic Psychosomatic Care” (CCP). Both complaints and findings should be explained clearly and reassuringly, and psychophysiological relationships should be explained (psychoeducation: e.g., vicious circles of resting, somatosensory amplification etc.) (17, e66) (EL 2a). This should connect with the patient’s subjective theory of the illness, so that a biospychosocial explanatory model can be built up (RG B). The physician should offer a positive description of the complaints (e.g., “non-specific,” “functional,” “bodily distress,” with a corresponding diagnosis if appropriate), but should not belittle (“There’s nothing wrong with you,”) or use stigmatizing terms (“hysteria”) (e66, e67) (EL 2b, RG B). Important elements are reassuring the patient that dangerous disease is unlikely (17, e56, e60) (EL 2b, RGA) and no unnecessary steps should be taken (“first, do no harm”, “quaternary prevention”) (e68) (EL 5, RG B), and furthermore long-term support with physical and social activation (7, e69, e70) (EL 2b). Medication (e.g., symptomatic medication for patients with irritable bowel syndrome, pain alleviation, treatment of psychological co-morbidity) should be discussed with the aim of alleviating symptoms within the framework of an overall treatment plan, carefully weighing the risks and benefits, and for a limited period (4) (CCP). Physicians should not be too quick to certify patients as unable to work, and should weigh the advantages (rest, relief from stress) against the disadvantages (avoidance, increased weakness due to rest, loss of participatory activity) early on (e83) (EL 4–5). Short-term sick notes (7 days, patient to attend again, another 7 days if appropriate) may be considered, in order to support spontaneous improvement of symptoms and promote the therapeutic relationship and/or adherence to treatment (RG B). Psychotherapy may be considered, e.g., if the patient wants to discuss psychosocial stressors or when the bodily complaints are incidental findings in, for example, a patient with depression (CCP).
Additional steps in severe courses
Even in severe courses, care at the primary level and specialist somatic medical level is at the center of management. Within the framework of a clear treatment plan, there should be a stronger structuring of the framework and content of treatment (e71) (EL 2a, RG B). Essential elements are regular appointments that are time-limited and are not complaint-led (e48, e71) (EL 2b) along with treatment of comorbid disorders in accordance with guidelines (RG B). Specific, realistic therapy goals should be developed with the patient (18, e72) (EL 2b, RG A), in the process of which the importance of self-responsibility and collaboration should be conveyed (EL 4). Physical activation (especially aerobic exercise [endurance training] and strength training of low to moderate intensity) should be carried out in stages, with slowly increasing work alternating with rest (7, e73–e76) (EL 2b, RG A) (Table 2) and should be accompanied by sustained encouragement. Similarly, the patient should be encouraged towards social activation (7, e69, e70). Some body-centered or nonverbal therapy elements and relaxation techniques (e.g., biofeedback, progressive muscle relaxation, autogenic training, tai chi, qi-gong, yoga, Feldenkrais, mindfulness training, meditation, writing as therapy, music therapy) may be recommended as additional elements within an overall treatment plan, but not as monotherapies (e77–e79) (EL 2a). In severe cases where pain predominates, low-dose, short-term antidepressant treatment should be given (7, 19, e80–e82) (EL 1a, RG A) (Table 1). In severe courses where pain does not dominate, treatment with antidepressants according to guidelines should be given only where there is relevant psychological co-morbidity (e5) (EL 2a, RG B). Referrals, especially psychosocial referrals, should be well organized and carefully discussed both before and after they take place (CCP).
Requesting a specialist psychosocial assessment will reduce health service utilization (20) (EL 1a, RG A). A consultation/care recommendation letter provided to the primary care physician (information about the patient’s illness and specific recommendations for treatment including assessment wether inpatient or day clinic treatment is indicated [Box 3]), which may if necessary be repeated, leads to improvement in the level of functioning and saves costs when used as an additional measure, but not on its own (21, 22) (EL 1a, RG A).
In severe courses, psychotherapeutic interventions should be disorder-/ or symptom-oriented-focused, context-related (co-morbidity, social situation, ability to work), and resource-oriented (CCP). Wider evidence is available for various NFS – with low to moderate effect sizes – especially for cognitive behavioral therapy (22–24, e80, e81, e84, e85) (EL 1a), and also for psychodynamic (interpersonal) (7, 25, e81, e86) (EL 1b) and hypnotherapeutic/imaginative approaches (e81, e85, e87, e88) (EL 1a, RG A) (Table 1). Follow-up studies showing positive effects are available for psychotherapy and physical activation, but not for medications (e74, e75, e81, e89).
Particularly severe courses: multimodal treatment, if necessary on an inpatient/day clinic basis
In particularly severe and chronic cases, multimodal treatment should already be initiated at the primary care and specialist somatic medical level (Box 2). Multimodal treatment has been shown to be effective especially for chronic pain syndrome (e90) (EL 1b, CCP). It should be assessed wether inpatient/day clinic treatment at a facility offering multimodal therapy at a clinic offering multimodal therapy is indicated, including when there are few or no options for treatment on an outpatient basis (Box 3) (e91, e92) (CCP).
Rehabilitation should also follow a multimodal approach (e93). The main goals are improvement in ability to function and to work, and to prevent (further) chronification. The sociomedical baseline situation (e.g. duration of inability to work) appears essential for success (e94) (CCP). In suitable facilities (e.g., day clinics with the appropriate range of indications/treatments), rehabilitation measures should be done at first on an outpatient basis, in close collaboration between primary care physician/somatic medical specialist and psychotherapist, and only after that on an inpatient or partly inpatient basis.
Reassessment after 3 months at the latest
To prevent cases become dangerous or chronic when this could have been prevented, complaints, diagnostic categorization, and the severity of illness and the outcome of treatment should be reassessed after 3 months at the latest (e56, e95) (EL 2b, RG B). If appropriate, and in agreement with the patient and collaborating physicians and therapists, both somatic and psychosocial diagnostic investigations and treatment should be adjusted. Basic medical diagnostic investigations including physical examination should be regularly repeated, especially where complaints persist. In this way, changes in symptoms will be recognized, organic disease will be identified, the patient will be given a feeling of being looked after and taken seriously, and unnecessary tests will be avoided (EL 5, RG B). After 6 months, if treatment on an outpatient basis fails, treatment on an inpatient or day clinic basis should be considered (Box 3).
In the S3 guideline “Management of patients with non-specific, functional, and somatoform bodily complaints,” a broad group of medical and psychological societies together with a patient representative have for the first time achieved an evidence-based consensus on terminology and care of these patients that is interdisciplinary and bridges the borders of health care sectors as well as psychosocial and somatic disciplines. The innovations are summarized in Box 4. To date, randomized controlled studies, reviews, and meta-analyses are available on only a few aspects (Figure 1), so that in places the present guideline has to rely on weaker evidence or clinical consensus. Overall, a very strong need is evident for fundamental research as well as research in treatment and health services. Guideline texts and practice materials may be downloaded from the AWMF website (www.awmf.org/ leitlinien/detail/ll/051–001.html) and from the project website (www.funktionell.net). An important complement to this guideline is the Evidence-Based Guideline on Psychotherapy of Somatoform Disorders and Associated Syndromes by the Group for Clinical Psychology and Psychotherapy of the German Society of Psychology (24). This is primarily aimed at psychotherapists as an aid to choosing effective psychotherapeutic interventions.
The authors are grateful to the AWMF, and to all colleagues, professional societies, and patient representatives (eBox 1) who contributed to the development of this guideline. Special thanks are due to Dipl.-Psych. Heribert Sattel as a member of the steering and editorial group.
Conflict of interest statement
P. Henningsen has received lecture fees from Lilly.
W. Häuser has been on an advisory board of Daiichi Sankyo, has had conference and travel expenses reimbursed by the Falk Foundation and Eli Lilly, and has received non-product-related lecture fees from the Falk Foundation and from Janssen-Cilag.
R. Schaefert, C. Hausteiner-Wiehle, M. Herrmann und J. Ronel declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
Manuscript received on 2 August 2012, revised version accepted on 19 September 2012.
Translated from the original German by Kersti Wagstaff, MA.
Dr. med. Rainer Schaefert
Klinik für Allgemeine Innere Medizin und Psychosomatik
Thibautstr. 2, 69115 Heidelberg, Germany
@For eReferences please refer to:
eBoxes, eTables, eFigure:
www.awmf.org/leitlinien/detail/ll/051–001.html (last accessed on 16 September 2012).
(last accessed on 16 September 2012).
Dr. med. Schaefert
Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München:
PD Dr. med. Hausteiner-Wiehle, Dr. med. Ronel, Prof. Dr. med. Henningsen
Department of Internal Medicine I, Klinikum Saarbrücken: PD Dr. med. Häuser
Institute of General Medicine, Otto-von-Guericke-Universität Magdeburg: Prof. Dr. med. Herrmann, MPH
|1.||Henningsen P, Hartkamp N, Loew T, Sack M, Scheidt CE, Rudolf G: Somatoforme Störungen. Leitlinien und Quellentexte. Schattauer 2002.|
|2.||Hausteiner-Wiehle C, Schaefert R, Sattel H, Ronel J, Herrmann M, Häuser W, Henningsen P: AWMF-Leitlinie zum Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. AWMF-Reg.-Nr. 051–001 2012; |
www.awmf.org/leitlinien/detail/ll/051–001.html (last accessed on 16 September 2012).
|3.||Hausteiner-Wiehle C, Schaefert R, Sattel H, Ronel J, Herrmann M, Häuser W, Henningsen P: AWMF-Leitlinie zum Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden – Leitlinienreport. AWMF-Reg.-Nr. 051–001 2012; http://www.awmf.org/leitlinien/detail/ll/051–001.html |
(last accessed on 16 September 2012).
|4.||Hausteiner-Wiehle C, Henningsen P, Häuser W, Herrmann M, Ronel J, Sattel H, Schäfert R: Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. S3-Leitlinien mit Quellentexten und Praxismaterialien. Schattauer, Stuttgart 2012; in press.|
|5.||Layer P, Andresen V, Pehl C, Allescher H, Bischoff SC, Classen M, et al.: S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) [Irritable Bowel Syndrome: German Consensus Guidelines on Definition, Pathophysiology and Management. German Society of Digestive and Metabolic Diseases (DGVS) and German Society of Neurogastroenterology and Motility (DGNM)]. Z Gastroenterol 2011; 49: 237–93. CrossRef MEDLINE|
|6.||Themenheft Fibromyalgiesyndrom – Eine interdisziplinäre S3-Leitlinie. Hintergründe und Ziele – Methodenreport – Klassifikation – Pathophysiologie – Behandlungsgrundsätze und verschiedene Therapieverfahren. Der Schmerz 2012; 26.|
|7.||Henningsen P, Zipfel S, Herzog W: Management of functional somatic syndromes. Lancet 2007; 369: 946–55. CrossRef MEDLINE|
|8.||Witthöft M, Hiller W: Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol 2010; 6: 257–83. CrossRef MEDLINE|
|9.||Creed F, Barsky A: A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004; 56: 391–408. CrossRef MEDLINE|
|10.||Guthrie E: Medically unexplained symptoms in primary care. Advances in Psychiatric Treatment 2008; 14: 432–40. CrossRef|
|11.||Körber S, Hiller W: Medizinisch unerklärte Symptome und somatoforme Störungen in der Primärmedizin [Medically unexplained symptoms and somatoform disorders in primary care]. J Neurol Neurochir Psychiatr 2012; 13: 21–8.|
|12.||Henningsen P, Zimmermann T, Sattel H: Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003; 65: 528–33. CrossRef MEDLINE|
|13.||Konnopka A, Schaefert R, Heinrich S, et al.: Economics of medically unexplained symptoms: A systematic review of the literature. Psychother Psychosom 2012; 81: 265–75. CrossRef MEDLINE|
|14.||Schneider G, Heuft G: Organisch nicht erklärbare somatoforme Beschwerden und Störungen im Alter: ein systematischer Literaturüberblick [Medically unexplained and somatoform complaints and disorders in the elderly: a systematic review of the literature]. Z Psychosom Med Psychother 2011; 57: 115–40. MEDLINE|
|15.||olde Hartman TC, Borghuis MS, Lucassen PL, van de Laar FA, Speckens AE, van Weel C: Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. J Psychosom Res 2009; 66: 363–77. MEDLINE|
|16.||Gask L, Dowrick C, Salmon P, Peters S, Morriss R: Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. J Psychosom Res 2011; 71: 325–34. CrossRef MEDLINE|
|17.||van der Feltz-Cornelis CM, Hoedeman R, Keuter EJ, Swinkels JA: Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. |
J Psychosom Res 2012; 72: 168–9. CrossRef MEDLINE
|18.||Gottschalk JM, Rief W: Psychotherapeutische Ansätze für Patienten mit somatoformen Störungen [Psychotherapeutic approaches for patients with somatoform disorders]. Nervenarzt 2012; 83: 1115–27. CrossRef MEDLINE|
|19.||Kapfhammer HP: Psychopharmakotherapeutische Ansätze bei somatoformen Störungen und funktionellen Körpersyndromen [Psychopharmacological treatment in patients with somatoform disorders and functional body syndromes]. Nervenarzt 2012; 83: 1128–41. CrossRef MEDLINE|
|20.||van der Feltz-Cornelis CM, van Os TW, van Marwijk HW, Leentjens AF: Effect of psychiatric consultation models in primary care. |
A systematic review and meta-analysis of randomized clinical trials. J Psychosom Res 2010; 68: 521–33. CrossRef MEDLINE
|21.||Hoedeman R, Blankenstein AH, van der Feltz-Cornelis CM, Krol B, Stewart R, Groothoff JW: Consultation letters for medically unexplained physical symptoms in primary care. Cochrane Database Syst Rev 2010; 12: CD006524. MEDLINE|
|22.||Kroenke K: Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007; 69: 881–8. CrossRef MEDLINE|
|23.||Kleinstäuber M, Witthoft M, Hiller W: Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: a meta-analysis. Clin Psychol Rev 2011; 31: 146–60. CrossRef MEDLINE|
|24.||Martin A, Härter M, Henningsen P, Hiller W, Kröner-Herwig B, Rief W: Evidenzbasierte Leitlinie zur Psychotherapie somatoformer Störungen und assoziierter Syndrome. Göttingen: Hogrefe 2012.|
|25.||Abbass A, Kisely S, Kroenke K: Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009; 78: 265–74. CrossRef MEDLINE|
|e1.||Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration 2011; www.cochrane-handbook.org (last accessed on 17 May 2012).|
|e2.||Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M: Levels of evidence and grades of recommendations. Oxford: Oxford Centre for Evidence-Based Medicine 2001. www.cebm.net/index.aspx?o=1025 (last accessed on 17 May 2012).|
|e3.||Hoffmann JC, Fischer I, Hohne W, Zeitz M, Selbmann HK: Methodische Grundlagen für die Ableitung von Konsensusempfehlungen [Methodological basis for the development of consensus recommendations]. Z Gastroenterol 2004; 42: 984–6. MEDLINE|
|e4.||AWMF, ÄZQ: Das Leitlinienmanual von AWMF und ÄZQ. Z Ärztl Fortbild Qualitätssich 2001; 95: 1–84; www.leitlinienmanual.de. MEDLINE|
|e5.||DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DPGs, DGRW (eds.) für die Leitliniengruppe Unipolare Depression*: S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Kurzfassung. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF 2009.|
|e6.||Ronel J, Noll-Hussong M, Lahmann C: Von der Hysterie zur F45.0. Geschichte, Konzepte, Epidemiologie und Diagnostik. Psychotherapie im Dialog 2008; 9: 207–16.|
|e7.|| Creed F, Fink P, Henningsen P, Rief W, Sharpe M, White P: |
Is there a better term than „Medically unexplained symptoms“? J Psychosom Res 2010; 68: 5–8. CrossRef MEDLINE
|e8.||Wessely S, Nimnuan C, Sharpe M: Functional somatic syndromes: one or many? Lancet 1999; 354: 936–9. CrossRef MEDLINE|
|e9.||Henningsen P, Derra C, Turp JC, Häuser W: Funktionelle somatische Schmerzsyndrome: Zusammenfassung der Hypothesen zur Überlappung und Ätiologie [Functional somatic pain syndromes: summary of hypotheses of their overlap and etiology]. Schmerz 2004; 18: 136–40. MEDLINE|
|e10.||Bleichhardt G, Martin A: Hypochondrie und Krankheitsangst. Göttingen: Hogrefe 2010.|
|e11.||Rief W, Broadbent E: Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev 2007; 27: 821–41. MEDLINE|
|e12.||Bensing JM, Verhaak PF: Somatisation: a joint responsibility of doctor and patient. Lancet 2006; 367: 452–4. MEDLINE|
|e13.||Widder B, Dertwinkel R, Egle UT, Foerster K, Schiltenwolf M: Leitlinie für die Begutachtung von Schmerzen. Psychotherapeut 2007; 52: 334–46.|
|e14.||Pither CE, Nicholas MK: Identification of iatrogenic factors in the development of chronic pain syndromes: abnormal treatment behavior? In: Bond MR, Charlton JE, Woolf CJ (eds.): Proceedings of the VIth World Congress on Pain. Amsterdam: 1991; 429–34.|
|e15.||Kouyanou K, Pither CE, Wessely S: Iatrogenic factors and chronic pain. Psychosom Med 1997; 59: 597–604. MEDLINE|
|e16.||Kouyanou K, Pither CE, Rabe-Hesketh S, Wessely S: A comparative study of iatrogenesis, medication abuse, and psychiatric morbidity in chronic pain patients with and without medically explained symptoms. Pain 1998; 76: 417–26. CrossRef MEDLINE|
|e17.||Page LA, Wessely S: Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. J R Soc Med 2003; 96: 223–7. CrossRef MEDLINE PubMed Central|
|e18.||Ring A, Dowrick CF, Humphris GM, Davies J, Salmon P: The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med 2005; 61: 1505–15. CrossRef MEDLINE|
|e19.||Salmon P, Humphris GM, Ring A, Davies JC, Dowrick CF: Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosom Med 2006; 68: 570–7. CrossRef MEDLINE|
|e20.||Salmon P, Wissow L, Carroll J, et al.: Doctors’ responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation? Gen Hosp Psychiatry 2007; 29: 454–60. MEDLINE|
|e21.||Salmon P: Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Educ Couns 2007; 67: 246–54. CrossRef MEDLINE|
|e22.||Wittchen HU, Jacobi F, Rehm J, et al.: The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21: 655–79.|
|e23.||Jacobi F, Wittchen HU, Holting C, et al.: Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004; 34: 597–611.|
|e24.||Kapfhammer HP: Geschlechtsdifferenzielle Perspektive auf somatoforme Störungen. Psychiatrie und Psychotherapie 2005; 1: 63–74. CrossRef|
|e25.||Creed F, Barsky A, Leiknes KA: Epidemiology: prevalence, causes and consequences. In: Creed F, Henningsen P, Fink P (eds.): Medically Unexplained Symptoms, Somatisation and Bodily Disgress. Developing Better Clinical Services. Cambridge: Cambridge University Press 2011; 1–42. CrossRef|
|e26.||Kanaan RA, Lepine JP, Wessely SC: The association or otherwise of the functional somatic syndromes. Psychosom Med 2007; 69: 855–9. CrossRef MEDLINE PubMed Central|
|e27.|| de Waal MW, Arnold IA, Eekhof JA, van Hemert AM: Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. |
Br J Psychiatry 2004; 184: 470–6. CrossRef MEDLINE
|e28.||Lieb R, Meinlschmidt G, Araya R: Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: an update. Psychosom Med 2007; 69: 860–3. CrossRef MEDLINE|
|e29.||Spitzer C, Barnow S, Wingenfeld K, Rose M, Lowe B, Grabe HJ: Complex post-traumatic stress disorder in patients with somatization disorder. Aust N Z J Psychiatry 2009; 43: 80–6. MEDLINE|
|e30.||Fröhlich C, Jacobi F, Wittchen HU: DSM-IV pain disorder in the general population. An exploration of the structure and threshold of medically unexplained pain symptoms. Eur Arch Psychiatry Clin Neurosci 2006; 256: 187–96. MEDLINE|
|e31.||Hasin D, Katz H: Somatoform and substance use disorders. Psychosom Med 2007; 69: 870–5. MEDLINE|
|e32.||Noyes R Jr, Langbehn DR, Happel RL, Stout LR, Muller BA, Longley SL: Personality dysfunction among somatizing patients. Psychosomatics 2001; 42: 320–9. MEDLINE|
|e33.||Garcia-Campayo J, Alda M, Sobradiel N, Olivan B, Pascual A: Personality disorders in somatization disorder patients: a controlled study in Spain. J Psychosom Res 2007; 62: 675–80. MEDLINE|
|e34.||Nanke A, Rief W: Zur Inanspruchnahme medizinischer Leistungen bei Patienten mit somatoformen Störungen. Psychotherapeut 2003; 48: 329–35. CrossRef|
|e35.||Barsky AJ, Orav EJ, Bates DW: Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005; 62: 903–10. CrossRef MEDLINE|
|e36.||Hilderink PH, Collard R, Rosmalen JG, Oudevoshaar RC: Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: A systematic review. Ageing Res Rev 2012. http://dx.doi.org/10.1016/j.arr.2012.04.004 CrossRef|
|e37.||Dreyer L, Kendall S, Danneskiold-Samsoe B, Bartels EM, Bliddal H: Mortality in a cohort of Danish patients with fibromyalgia: increased frequency of suicide. Arthritis Rheum 2010; 62: 3101–8. MEDLINE|
|e38.||Wolfe F, Hassett AL, Walitt B, Michaud K: Mortality in fibromyalgia: a study of 8,186 patients over thirty-five years. Arthritis Care Res (Hoboken ) 2011; 63: 94–101. CrossRef MEDLINE|
|e39.||Aiarzaguena JM, Grandes G, Salazar A, Gaminde I, Sanchez A: The diagnostic challenges presented by patients with medically unexplained symptoms in general practice. Scand J Prim Health Care 2008; 26: 99–105. MEDLINE PubMed Central|
|e40.||Ilgen MA, Zivin K, McCammon RJ, Valenstein M: Pain and suicidal thoughts, plans and attempts in the United States. Gen Hosp Psychiatry 2008; 30: 521–7. MEDLINE PubMed Central|
|e41.||Fishbain DA, Bruns D, Disorbio JM, Lewis JE: Risk for five forms of suicidality in acute pain patients and chronic pain patients vs pain-free community controls. Pain Med 2009; 10: 1095–105. CrossRef MEDLINE|
|e42.||Hahn SR, Kroenke K, Spitzer RL, et al.: The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med 1996; 11: 1–8. MEDLINE|
|e43.||Hahn SR: Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Ann Intern Med 2001; 134: 897–904. MEDLINE|
|e44.||Jackson JL, Kroenke K: Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med 1999; 159: 1069–75. CrossRef MEDLINE|
|e45.||Hausteiner-Wiehle C, Grosber M, Bubel E, et al.: Patient-doctor interaction, psychobehavioural characteristics and mental disorders in patients with suspected allergies: do they predict „medically unexplained symptoms“? Acta Derm Venereol 2011; 91: 666–73. MEDLINE|
|e46.||Walker EA, Unutzer J, Katon WJ: Understanding and caring for the distressed patient with multiple medically unexplained symptoms. J Am Board Fam Pract 1998; 11: 347–56. MEDLINE|
|e47.||Smith RC, Lein C, Collins C, et al.: Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med 2003; 18: 478–89. MEDLINE|
|e48.||Heijmans M, olde Hartman TC, Weel-Baumgarten E, Dowrick C, Lucassen PL, van Weel C: Experts’ opinions on the management of medically unexplained symptoms in primary care. A qualitative analysis of narrative reviews and scientific editorials. Fam Pract 2011; 28: 444–55. MEDLINE|
|e49.||Thorne SE, Harris SR, Mahoney K, Con A, McGuinness L: The context of health care communication in chronic illness. Patient Educ Couns 2004; 54: 299–306. MEDLINE|
|e50.||Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG: „Could this be something serious?“ Reassurance, uncertainty, and empathy in response to patients’ expressions of worry. J Gen Intern Med 2007; 22: 1731–9. MEDLINE PubMed Central|
|e51.||Schäfert R, Boelter R, Faber R, Kaufmann C: Tangential, nicht frontal – Annäherung an eine schwierige Patientengruppe. Psychotherapie im Dialog 2008; 9: 252–9.|
|e52.||Arbeitskreis PISO: PISO: Psychodynamisch-Interpersonelle Therapie bei somatoformen Störungen. Eine manualisierte Kurzzeitintervention. Göttingen: Hogrefe 2011.|
|e53.||Anderson M, Hartz A, Nordin T, et al.: Community physicians’ strategies for patients with medically unexplained symptoms. Fam Med 2008; 40: 111–8. MEDLINE|
|e54.||Aiarzaguena JM, Grandes G, Gaminde I, Salazar A, Sanchez A, Arino J: A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med 2007; 37: 283–94. CrossRef MEDLINE|
|e55.||Bieber C, Muller KG, Blumenstiel K, et al.: A shared decision-making communication training program for physicians treating fibromyalgia patients: effects of a randomized controlled trial. J Psychosom Res 2008; 64: 13–20. MEDLINE|
|e56.||Fink P, Rosendal M, Toft T: Assessment and treatment of functional disorders in general practice: the extended reattribution and management model–an advanced educational program for nonpsychiatric doctors. Psychosomatics 2002; 43: 93–131. CrossRef MEDLINE|
|e57.||Toft T, Rosendal M, Ornbol E, Olesen F, Frostholm L, Fink P: Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study). Psychother Psychosom 2010; 79: 227–37. CrossRef MEDLINE|
|e58.||Creed F, van der Feltz-Cornelis C, Guthrie E, et al.: Identification, assessment and treatment of individual patients. In: Creed F, Henningsen P, Fink P (eds.): Medically unexplained symptoms, somatisation and bodily distress. Cambridge: Cambridge University Press 2011; 175–216. CrossRef|
|e59.||Hennigsen P, Rüger U, Schneider W: Die Leitlinie „Ärztliche Begutachtung in der Psychosomatik und Psychotherapeutischen Medizin: Sozialrechtsfragen“. Versicherungsmedizin 2001; 53: 138–41. MEDLINE|
|e60.||van Bokhoven MA, Koch H, van der Weijden T, et al.: Influence of watchful waiting on satisfaction and anxiety among patients seeking care for unexplained complaints. Ann Fam Med 2009; 7: 112–20. MEDLINE|
|e61.||Petrie KJ, Muller JT, Schirmbeck F, et al.: Effect of providing information about normal test results on patients’ reassurance: randomized controlled trial. BMJ 2007; 334: 352. MEDLINE|
|e62.||Kirmayer LJ, Robbins JM: Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis 1991; 179: 647–55. CrossRef MEDLINE|
|e63.||Smith RC, Dwamena FC: Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med 2007; 22: 685–91. CrossRef MEDLINE PubMed Central|
|e64.||Hotopf M: Preventing somatization. Psychol Med 2004; 34: 195–8. CrossRef MEDLINE|
|e65.||Fink P, Rosendal M: Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry 2008; 21: 182–8. CrossRef MEDLINE|
|e66.||Dowrick CF, Ring A, Humphris GM, Salmon P: Normalisation of unexplained symptoms by general practitioners: a functional typology. Br J Gen Pract 2004; 54: 165–70. MEDLINE PubMed Central|
|e67.||Stone J, Wojcik W, Durrance D, et al.: What should we say to patients with symptoms unexplained by disease? The „number needed to offend“. BMJ 2002; 325: 1449–50. MEDLINE|
|e68.||Starfield B, Hyde J, Gervas J, Heath I: The concept of prevention: a good idea gone astray? J Epidemiol Community Health 2008; 62: 580–3. MEDLINE|
|e69.||Richardson RD, Engel CC Jr: Evaluation and management of medically unexplained physical symptoms. Neurologist 2004; 10: 18–30. MEDLINE|
|e70.||Stuart S, Noyes R Jr: Interpersonal psychotherapy for somatizing patients. Psychother Psychosom 2006; 75: 209–19. CrossRef MEDLINE|
|e71.||Pols RG, Battersby MW: Coordinated care in the management of patients with unexplained physical symptoms: depression is a key issue. Med J Aust 2008; 188: 133–7. MEDLINE|
|e72.||Timmer B, Bleichhardt G, Rief W: Effektivität einer stationären Gruppentherapie für Patienten mit multiplem somatoformen Syndrom: Ergebnisse einer kontrolliert-randomisierten Therapieevaluationsstudie [Effectiveness of a cognitive-behavioral group therapy for somatization – Results of a randomized controlled trial in tertiary care]. Zeitschrift für Klinische Psychologie und Psychotherapie 2004; 33: 24–32.|
|e73.||Edmonds M, McGuire H, Price J: Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2004; CD003200. MEDLINE|
|e74.|| Daley AJ, Grimmett C, Roberts L, et al.: The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomized controlled trial. |
Int J Sports Med 2008; 29: 778–82. CrossRef MEDLINE
|e75.||Johannesson E, Simren M, Strid H, Bajor A, Sadik R: Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011; 106: 915–22. CrossRef MEDLINE|
|e76.||Winkelmann A, Häuser W, Friedel E, et al.: Physiotherapie und physikalische Verfahren beim Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie [Physiotherapy and physical therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. Schmerz 2012; 26: 276–86.|
|e77.||Thieme K, Gracely RH: Are psychological treatments effective for fibromyalgia pain? Curr Rheumatol Rep 2009; 11: 443–50. CrossRef MEDLINE|
|e78.||Baranowsky J, Klose P, Musial F, Häuser W, Dobos G, Langhorst J: Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatol Int 2009; 30: 1–21. CrossRef MEDLINE|
|e79.|| Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG: Psychological treatments for fibromyalgia: |
a meta-analysis. Pain 2010; 151: 280–95. CrossRef MEDLINE
|e80.||Sumathipala A: What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med 2007; 69: 889–900. CrossRef MEDLINE|
|e81.||Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P: Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009; 58: 367–78. CrossRef MEDLINE|
|e82.||Sommer C, Häuser W, Alten R, et al.: Medikamentöse Therapie des Fibromyalgiesyndroms. Systematische Übersicht und Metaanalyse [Drug therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. Schmerz 2012; 26: 297–310.|
|e83.||Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW: The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil 2010; 20: 264–73. CrossRef MEDLINE PubMed Central|
|e84.||Price JR, Mitchell E, Tidy E, Hunot V: Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008; CD001027. MEDLINE|
|e85.||Köllner V, Häuser W, Klimczyk K, et al.: Psychotherapie von Patienten mit Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie [Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. Schmerz 2012; 26: 291–6.|
|e86.||Sattel H, Lahmann C, Gündel H, et al.: Brief psychodynamic-interpersonal psychotherapy for patients with multisomatoform disorder: A randomized controlled trial. Br J Psychiatry 2011; 200(1): 60−7. MEDLINE|
|e87.||Hefner J, Rilk A, Herbert BM, Zipfel S, Enck P, Martens U: Hypnotherapeutische Interventionen beim Reizdarmsyndrom – eine systematische Übersicht [Hypnotherapy for irritable bowel syndrome–a systematic review]. Z Gastroenterol 2009; 47: 1153–9. MEDLINE|
|e88.|| Bernardy K, Fuber N, Klose P, Häuser W: Efficacy of hypnosis/|
guided imagery in fibromyalgia syndrome – a systematic review and meta-analysis of controlled trials. BMC Musculoskelet Disord 2011; 12: 133. CrossRef MEDLINE PubMed Central
|e89.||Eich W, Häuser W, Arnold B, et al.: Das Fibromyalgiesyndrom. Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung [Fibromyalgia syndrome. General principles and coordination of clinical care and patient education]. Schmerz 2012; 26: 268–75.|
|e90.||Arnold B, Häuser W, Arnold M, et al.: Multimodale Therapie des Fibromyalgiesyndroms. Systematische Übersicht, Metaanalyse und Leitlinie [Multicomponent therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. Schmerz 2012; 26: 287–90.|
|e91.||Bleichhardt G, Timmer B, Rief W: Cognitive-behavioural therapy for patients with multiple somatoform symptoms – a randomized controlled trial in tertiary care. J Psychosom Res 2004; 56: 449–54. CrossRef MEDLINE|
|e92.||Beutel ME, Michal M, Subic-Wrana C: Psychoanalytically-oriented inpatient psychotherapy of somatoform disorders. J Am Acad Psychoanal Dyn Psychiatry 2008; 36: 125–42. CrossRef MEDLINE|
|e93.||Witte B: Stationäre psychosomatische Rehabilitation bei Patienten mit chronischen Kopfschmerzen und somatoformen Schmerzstörungen. Psychotherapie Forum 2010; 18: 146–52. CrossRef|
|e94.||Hoffmann C, Ruf-Ballauf W: Stationäre psychosomatische Rehabilitation bei Patienten mit somatoformen Störungen sowie Patienten mit sozialmedizinisch relevanten Problemen: Ergebnisse einer Zweijahreskatamnese [Psychosomatic rehabilitation of in-patients with somatoform disorders and of patients with social-medically relevant problems: results of a two-year follow-up]. Rehabilitation 2007; 46: 283–95. CrossRef MEDLINE|
|e95.||Dunn KM, Croft PR: Repeat assessment improves the prediction of prognosis in patients with low back pain in primary care. Pain 2006; 126: 10–5. CrossRef MEDLINE|
|e96.||Reid S, Wessely S, Crayford T, Hotopf M: Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. Br J Psychiatry 2002; 180: 248–53. CrossRef MEDLINE|
|e97.||van der Feltz-Cornelis CM, van Oppen P, Ader HJ, van Dyck R: 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. CrossRef MEDLINE|
|e98.||Voigt K, Nagel A, Meyer B, Langs G, Braukhaus C, Lowe B: Towards positive diagnostic criteria: a systematic review of somatoform disorder diagnoses and suggestions for future classification. J Psychosom Res 2010; 68: 403–14. CrossRef MEDLINE|
|e99.||Henningsen P, Fink P, Hausteiner-Wiehle C, Rief W: Terminology, classification and concepts. In: Creed F, Henningsen P, Fink P (eds.): Medically unexplained symptoms, somatisation and bodily distress. Developing better clinical services. Cambridge: Cambridge University Press 2011; 43–68. CrossRef|
|e100.||Creed FH, Davies I, Jackson J, et al.: The epidemiology of multiple somatic symptoms. J Psychosom Res 2012; 72: 311–7. MEDLINE|
|e101.||Norman GR, Sridhar FG, Guyatt GH, Walter SD: Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Med Care 2001; 39: 1039–47. CrossRef MEDLINE|