Abstract

Background

Patients with severe somatoform disorder (in secondary and tertiary care) typically experience functional impairment associated
with physical symptoms and mental distress. Although psychotherapy is the preferred treatment, its effectiveness remains to
be demonstrated.

Aims

To examine the effectiveness of psychotherapy for severe somatoform disorder in secondary and tertiary care compared with
treatment as usual (TAU) but not waiting-list conditions.

Method

Main inclusion criteria were presence of a somatoform disorder according to established diagnostic criteria and receiving
psychotherapy for somatoform disorder in secondary and tertiary care. Both randomised and non-randomised trials were included.
The evaluated outcome domains were physical symptoms, psychological symptoms (depression, anxiety, anger, general symptoms)
and functional impairment (health, life satisfaction, interpersonal problems, maladaptive cognitions and behaviour).

Results

Ten randomised and six non-randomised trials were included, comprising 890 patients receiving psychotherapy and 548 patients
receiving TAU. Psychotherapy was more effective than TAU for physical symptoms (d = 0.80 v. d = 0.31, P0.05) and functional impairment (d = 0.45 v. d = 0.15, P0.01), but not for psychological symptoms (d = 0.75 v. d = 0.51, P = 0.21). These effects were maintained at follow-up.

Conclusions

Overall findings suggest that psychotherapy is effective in severe somatoform disorder. Future randomised controlled studies
should examine specific interventions and mechanisms of change.