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OBJECTIVE: Disturbances in emotional processes are commonly reported in patients with a somatic symptom disorder (SSD). Although emotions usually occur in social interactions, little is known about interpersonal emotion dynamics of SSD patients during their actual emotional encounters. This study examined physiological coherence (linkage) between SSD patients and their partners, and in healthy couples during their emotional interactions. Secondarily, we explored group-level relationships between participants' and their partners' subjective affect. METHODS: Twenty-nine romantic couples (16 healthy and 13 SSD patient-couples) underwent a dyadic conversation task with neutral and anger-eliciting topics followed by a guided relaxation. Partners' cutaneous facial temperature was recorded simultaneously by functional infrared thermal imaging. Immediately after each condition, participants reported on their pain intensity, self-affect, and perceived partner-affect. RESULTS: Emotional conditions and having a partner with an SSD significantly affected coherence amplitude on the forehead (F(2,54) = 4.95, p = .011) and nose tip temperature (F(2,54) = 3.75, p = .030). From baseline to anger condition, coherence amplitude significantly increased in the patient-couples, whereas it decreased in the healthy couples. Correlation changes between partners' subjective affect comparably accompanied the changes in physiological coherence in healthy and patient-couples. CONCLUSIONS: Inability to reduce emotional interdependence in sympathetic activity and subjective affect during a mutual conflict observed in SSD patient-couples seems to capture emotion co-dysregulation. Interventions should frame patients' emotional experiences as embodied and social. Functional infrared thermal imaging confirms to be an ecological and reliable method for examining autonomic changes in interpersonal contexts.Registration Page: https://osf.io/8eyjr. ispartof: Psychosomatic Medicine vol:84 issue:2 pages:188-198 ispartof: location:United States status: published

Die ICD-11 wahlt einen grundlegendend neuen Zugang zu den bisherigen somatoformen Storungen und ihren verwandten Krankheitsbildern. Die neue Bezeichnung »Bodily Distress Disorder« (deutsch voraussichtlich »Somatische Belastungsstorung«) ruckt die zirkulare Dynamik von Stress und Korperbeschwerden in den Fokus: Eine Vielzahl von Belastungen kann zu Beschwerden fuhren und gleichzeitig durch Beschwerden entstehen, insbesondere bei ubermasiger Ausrichtung des Denkens und Handelns darauf. Der bisherige einseitige und zudem dualistische Fokus auf die Beschwerdeatiologie (Ausschluss organischer Ursachen; bei chronischen Schmerzstorungen mit somatischen und psychischen Faktoren Forderung organischer Ursachen und psychischer Verstarker, aber Ausschluss psychischer Ursachen; bei dissoziativen Storungen und somatoformen Schmerzstorungen Forderung psychischer Ursachen) ist verschwunden. Allerdings bleibt es bei einer Verortung der Krankheitsbilder bei den psychischen Storungen sowie bei einer Parallelklassifikation mit funktionellen gastrointestinalen und neurologischen Storungsbildern. Das neue Konzept des »chronischen primaren Schmerzes« wandert ins Symptom-Kapitel. Es gibt also nach wie vor keine verbindende Bruckenkategorie, die die enge Verwobenheit psychophysischer Mechanismen und damit die Notwendigkeit einer interdisziplinaren Herangehensweise klar macht.

The aim of this study was to identify and explore mediators of psychodynamic-interpersonal psychotherapy (PIT) on treatment outcome in multisomatoform disorders (MSD).Data from 164 patients with MSD who took part in a randomized control trial of PIT (Stress partially mediated the effect of PIT vs. EMC on the follow-up outcome. PIT (as compared to EMC) led to lower post-treatment stress-levels, which in turn led to higher physical quality of life at follow-up. Neither depression nor the alliance had a mediating effect.Stress mediated the outcome of PIT for MSD. Future studies are needed to extend the scope of research regarding which specific psychotherapeutic mechanisms of change are beneficial in PIT treatment of MSD patients.

Medically unexplained physical symptoms are frequently named by adolescents in both clinical and normative samples. This study analyzed the associations between parental rearing styles and adolescents' body complaints in diverse cultural contexts. In a cross-cultural study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of maternal and paternal support, psychological control, and an anxious parental monitoring style with youth body complaints were tested. Girls reported more somatic complaints than boys, the level of complaints differed between countries, and gender differences varied significantly between countries. Hierarchic multilevel models revealed that the expression of distress via body complaints, after controlling for country, gender, and sociodemographic status, was significantly associated with parental rearing styles. The negative impact of mothers' psychological control on body complaints generalize across countries. In addition, mothers' anxious monitoring had a negative impact on the offspring's health, whereas higher levels of paternal support and lower levels of paternal psychological control contributed to lower levels of somatic complaints. Sociodemographic variables such as family structure, standard of living, and employment status of the parents, did not turn out as significant in the final model. The findings point to the different roles of fathers and mothers play in adolescents' health and their complex interplay.

To assess the stability of somatic symptoms in community-dwelling participants.The study included 2472 participants (1190 men, 1282 women; mean age 44.3 ± 10.9) from the prospective population-based MONICA-S3 cohort (1994/95) and the 10-year follow-up KORA-F3 cohort. Somatic symptoms were assessed by an adapted version of the Somatic Symptom Scale-8 (SSS-8a) with scores ranging from 0 to 24. Somatic symptom stability was assessed by weighted kappa values (κ). Generalized Estimating Equation models assessing symptom stability were adjusted for sociodemographic, lifestyle, clinical and psychosocial risk factors, as well as pre-existing medical conditions.The mean (±SD) SSS-8a was lower in men (S3: 6.88 ± 3.87, F3: 6.60 ± 3.86) than women (S3: 8.43 ± 4.0, F3: 8.31 ± 4.2) at both time points. However, somatic symptoms remained moderately stable in both genders over 10 years (κ =0.42 in men and κ = 0.48 in women), with the largest stability observed in trouble sleeping for men (κ =0.41) and pain in the joints for women (κ =0.41). Pre-existing somatic symptoms were significantly associated with increasing symptoms at follow-up [men: β = 0.82 (SE 0.12), women: β = 0.85 (SE 0.12)], followed by age and psychosocial factors, whereas higher education and recent health care utilization were inversely associated with increasing symptoms. Although hypertension and obesity were associated with increasing somatic symptoms in men, pre-existing medical conditions were not associated with increasing somatic symptoms in men nor women.The current findings indicate that somatic symptoms remain moderately stable in the general population during 10 years of follow-up, mainly driven by sociodemographic and psychosocial factors.

BACKGROUND: Chronic tinnitus is a commonly occurring symptom of the auditory system. Epidemiological studies assume a lifetime prevalence in men and women of 3.5% for chronic tinnitus requiring treatment. Almost 25% of all Germans have experienced at least one episode of tinnitus. No causal therapy is yet available, but numerous treatment strategies are being pursued. Rigorous scientific assessment of these procedures is essential. METHODS: For this exhaustive revision of the German clinical practice guideline, the literature in the medical databases PubMed and Cochrane Library, including existing guidelines from various countries, was systematically searched using keywords on the topic of chronic tinnitus. On the basis of the revised guideline, a separate guideline was written in language accessible to patients. RESULTS: Chronic tinnitus is often associated with hearing loss, but the mental distress caused by the ear noise is another crucial element. Apart from expert counseling, the recommended treatment comprises psychotherapeutic interventions, particularly cognitive behavioral therapy (with effect sizes of 0.54 to 0.91 for reduction of the tinnitus-related distress), and measures to improve the hearing. There is insufficient evidence regarding the effects of drug treatment, sound and music therapy, and neuromodulation (magnetic stimulation or electrostimulation). CONCLUSION: Alongside thorough and sound diagnosis and counseling, the principal treatment options for chronic tinnitus are specific cognitive behavioral therapy and expert psychotherapeutic interventions on an individual or group basis. Future—preferably interdisciplinary—research should evaluate the long-term effects of the treatment options, with particular attention to psychosomatic comorbidity.

More than 1 million Syrian refugees have sought asylum in Europe since 2011. Disastrous conditions in their country and an arduous flight increased the risk for the emergence of physical and mental problems, especially in children. We performed a comprehensive medical and psychological examination in 96 Syrian refugee children aged 0–14 years in a German reception camp. Parents were interviewed and answered questions on health, flight and living conditions. In the children, we found most frequently somatic and in particular dental problems, incomplete immunization state and mental disorders. Post-traumatic stress disorder (PTSD) was diagnosed in 30.2 per cent of the children. Fifty-seven per cent of the parents reported somatic complaints; most of them were neurological (e.g. headache) and sleep disorders. Syrian refugee children show a significant rate of PTSD, somatic disorders and incomplete immunization state. The separation from family members during flight and physical complaints of the parents were identified as risk factors for PTSD in the children of our study. Early combined acute and preventive health-care management for children and their parents is indicated.

Objectives Functional vertigo and dizziness (VD) are frequent and severely distressing complaints that are often described as hard to treat. Our aim was to provide preliminary data on potential effects of multimodal psychosomatic inpatient therapy for patients with functional VD symptoms in reducing vertigo-related handicap and related psychopathology, and to evaluate the role of symptom burden and body-related locus of control in predicting vertigo-related handicap at follow-up. Design We conducted an uncontrolled clinical pilot trial. Methods We included data of n = 72 inpatients with functional VD as a primary symptom and various psychopathological and/or physical comorbidities admitted for multimodal psychosomatic inpatient treatment. Patients completed self-report questionnaires assessing vertigo-related handicap (VHQ), somatization (PHQ-15), depression (BDI-II), anxiety (BAI), health-related quality of life (HRQOL; SF-36), and body-related locus of control (KLC) at admission (T0), discharge (T1), and 6 months after discharge (T2). Results We observed medium effects for the change of vertigo-related handicap (T0-T1: g = -0.60, T0-T2: g = -0.67) and small effects for the change of somatization (T0-T1: g = -0.29, T0-T2: g = -0.24), mental HRQOL (T0-T1: g = 0.43, T0-T2: g = 0.49), and depression (T0-T1: g = -0.41, T0-T2: g = -0.28) from admission to discharge and admission to follow-up. Body-related locus of control did not predict vertigo-related handicap at follow-up. Conclusions Findings provide preliminary evidence for the beneficial role of psychosomatic inpatient treatment for patients with functional VD symptoms. Potentially relevant predictors of outcome at follow-up are discussed. Practitioner points The change of vertigo-related handicap and related variables through multimodal psychosomatic inpatient treatment was evaluated in a clinical pilot trial in patients with functional vertigo and dizziness. We observed medium effects for the change of vertigo-related handicap and small effects for the change of somatization, mental health-related quality of life, and depression. Internal body-related locus of control at admission did not predict vertigo-related handicap at follow-up.

Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.

Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD.In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires.Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms.Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.

BackgroundSomatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD.ObjectivesThis review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies.Data sourcesPsycINFO and PubMed databases for the articles published between January 1985 and June 2018.Search terms"emotion/al regulation" or "affect regulation" and various forms of SSD.Study eligibility criteriaEmpirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included.Study synthesis methodsA tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge).ResultsThe findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material.LimitationsThere is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous.Conclusions and implicationsAssessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.

We tested the efficacy of an integrative psychotherapeutic group treatment (IPGT) in reducing vertigo/dizziness-related impairment along with depression, anxiety, and somatization by conducting a randomized controlled superiority trial comparing IPGT to self-help groups moderated by a clinical psychologist (SHG). Adult patients with functional vertigo and dizziness symptoms were randomly allocated to either the IPGT or SHG as active control group. Outcomes were assessed at baseline (t0), after treatment lasting 16 weeks (t1), and 12 months after treatment (t2). A total of 81 patients were assigned to IPGT and 78 patients were assigned to SHG. Vertigo-related impairment was reduced in both conditions (IPGT: t0–t1: d = 1.10, t0–t2: d = 1.06, SHG: t0–t1: d = 0.86, t0–t2: d = 1.29), showing the efficiency of both IPGT and SHG. Clinically relevant improvements were also obtained for depression in both groups. Linear mixed model analyses revealed no differences between groups for all outcomes (effect of group for the primary outcome: b = −1.15, SE = 2.13, t = −0.54, p = 0.59). Attrition rates were higher in SHG (52.6%) than in IPGT (28.4%). Both conditions improved primary and secondary outcomes while IPGT was better accepted by patients than SHG. Trial registration: ClinicalTrials.gov, Identifier: NCT02320851.

Self-management interventions (SMI) are a heterogeneous group of interventions that are regarded as important tools (medically, economically) for the management of chronic diseases. They consist of a broad range of techniques and are available for a large variety of chronic organic as well as mental conditions or illnesses, which are by definition generally chronic. Surprisingly, only a few reports are available from this realm, as compared to those of chronic and clearly organic conditions, such as diabetes and arthritis. This may be due to inconsistency in the usage of the term "self-management interventions", when brought about by lack of clarity about the use of the term self in the context of mental conditions. A major conceptual weakness of the term "self" is that it has different context-related meanings. In the domain of mental conditions, a patient is likely to suffer from possible or probable dysfunctional aspects of his or her "Self", which should be targeted appropriately during psychotherapy. In psychosomatic medicine, Self-models are traditionally well developed. Based on a structural model of the Self, psychodynamic "structure-related psychotherapy" provides a powerful tool for the treatment of mental conditions with moderate to severe impairments of structural functioning.

Objective DSM-5 somatic symptom disorder (SSD) could potentially be a highly relevant diagnosis for patients with vertigo and dizziness. The criteria of SSD, particularly the B-criterion with its three components (cognitive, affective, behavioral), have however not yet been investigated in this patient group. Methods We evaluated a large sample ( n = 399) of outpatients presenting in a neurological setting. Physical examinations and a psychometric assessment (SCID-I) were conducted; patients completed self-report questionnaires. The diagnosis of SSD was assigned retrospectively. The prevalence of SSD, its diagnostic criteria, and its overlap with former DSM-IV somatoform disorders were evaluated; comparisons were drawn between (1) patients fulfilling different components of the B-criterion and (2) patients with diagnoses after DSM-IV vs. DSM-5 . Results SSD was almost twice as common as DSM-IV somatoform disorders. Patients with all three components of the B-criterion reported the highest impairment levels. Patients with both DSM-IV somatoform disorders and DSM-5 SSD were more impaired compared to groups with one of the diagnoses; patients with DSM-IV somatoform disorders only were more impaired than those with SSD only. Conclusions Our findings demonstrate that SSD is highly prevalent in patients with vertigo and dizziness. The classification of severity based on the number of psychological symptoms appears valid and may assist in finding suitable treatment options according to clinical practice guidelines. Future studies should investigate the overlap of SSD and other psychiatric disorders, this may assist in better defining the diagnostic criteria of SSD.

Ein Patient klagt uber Ruckenschmerzen, aber weder Anamnese noch korperliche Untersuchung ergeben Hinweise auf eine behandlungsbedurftige korperliche Erkrankung. Jetzt gilt es, den Patienten weder abzuwimmeln noch seinem (oder sogar dem eigenen) Wunsch nach mehr Diagnostik nachzugeben. Wie konnen wir Patienten mit unklaren Korperbeschwerden helfen, sodass beide Seiten mit der Behandlung zufrieden sind?

Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare.Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care.The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed.With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well asthe application and publication of reviews for different psychometric instruments based on the review model.

Adult attachment representations have been considered to play a role in the development and treatment of somatizing behavior. In this study, the associations between the two attachment dimensions avoidance and anxiety and dimensions of psychopathology (somatization, depression, and general anxiety) were explored. The sample consists of 202 outpatients diagnosed with a somatoform disorder. Data were collected via self-report measures. A path analysis shows that the two attachment dimensions are not directly associated with somatization. There are, however, significant indirect associations between attachment and somatization mediated by depression and general anxiety, which are more pronounced for attachment anxiety than for attachment avoidance. The findings reveal that a low level of attachment security in romantic relationships, especially an anxious stance toward the partner, comes along with poor mental health, which in turn is related to a preoccupation with somatic complaints. Implications for the treatment of somatizing patients are discussed.

This paper presents data on significant cultural influences on pain related psychosocial work place conditions, one of the core issues of psycho-somatic medicine, and discusses consequences for a cultural neuroscience of pain. Chronic pain encompasses the experience of the pain sensation itself and a whole universe of related emotions, thoughts, behaviors and suffering, whilst tissue damage is no necessary precondition for it. A biopsychosocial view on risk factors typically concentrates on the intra-individual level and includes genetic dispositions or injuries, e.g., whilst an embodied approach emphasizing the “body being in the world”, integrating cultural perspectives seems more appropriate. However, recent epidemiological work demonstrated the relevance of group level psychosocial risk factors for chronic pain. Lack of social support at work, injustice, high job strain and effort-reward imbalance are important here. Nevertheless, even these perspectives do not capture all relevant differences: Studies in different societies reveal significant cultural influences, both in an “etic” and in an “emic” perspective. The link between culture and pain involves different aspects. Culturally shaped ways of world-making influence interpretation, labeling and treatment of distress. Now, additional knowledge on the relational biology of pain reveals, how culture determines differences in neural processes underlying emotion and pain experience.

Mit der S3-Leitlinie „Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Korperbeschwerden (NFS)“ (AWMF Registernr. 051–001) gibt es erstmals einen breiten, evidenzbasierten Konsens uber psychosoziale und somatische Disziplinen hinweg zu Terminologie und Versorgung dieser grosen, gerade in der Schmerzmedizin hochrelevanten Patientengruppe.

Nicht-spezifische, funktionelle und somatoforme Korperbeschwerden (NFS) sind ein haufiges und oft chronisches Phanomen in der Haus- und Facharztmedizin. Die Patienten sind erheblich in ihrer Lebensqualitat beeintrachtigt, die direkten und indirekten Folgekosten sind hoch. Fur den Arzt bedeutet ihre Behandlung eine Herausforderung, im ungunstigen Falle kann das Verhalten des Arztes den Verlauf negativ beeinflussen. Unter Federfuhrung der beiden Fachverbande fur Psychosomatische Medizin wurde kurzlich eine umfassende, evidenzbasierte und interdisziplinare S3-Leitlinie zum Umgang mit Patienten mit NFS entwickelt. Diese beschreibt die wesentlichen Elemente der arztlichen Grundhaltung und Gesprachsfuhrung sowie des diagnostischen und therapeutischen Vorgehens aufgrund der aktuellen empirischen Befundlage. Der Aufbau einer partnerschaftlichen Arbeitsbeziehung sowie eine symptom- und bewaltigungsorientierte Grundhaltung begunstigen die Behandlung von Patienten mit NFS. Die biopsychosoziale Simultandiagnostik umfasst die Erhebung der Korperbeschwerden plus organischer Basisdiagnostik und von Beginn an eine psychosoziale Basisanamnese, die bei Hinweisen auf psychosoziale Belastungen erweitert wird. Bei leichteren Verlaufen reicht meist die Behandlung durch den Hausarzt, auf der Grundlage therapeutischer Masnahmen aus der psychosomatischen Grundversorgung. Schwerere Verlaufe werden in einem starker strukturierten Setting behandelt, sie bedurfen regelmasiger und beschwerdeunabhangiger Termine und erfordern die Mitarbeit des Patienten in hoherem Mase. Erforderlich ist der koordinierte und kooperative Einsatz weiterer Elemente aus den Bereichen gestufte Aktivierung, Psychotherapie, Entspannungsverfahren sowie ggf. befristete Medikation. Besonders schwere Verlaufe bedurfen einer multimodalen Behandlung, ggf. im (teil-)stationaren Setting.

Mit der S3-Leitlinie „Nicht-spezifische, funktionelle und somatoforme Korperbeschwerden“ wurde erstmals uber psychosoziale und somatische Disziplinen hinweg ein breiter, evidenzbasierter Konsens zu Terminologie und Versorgung erreicht. Dieser Beitrag fasst die fur Psychotherapeuten wesentlichen Hintergrundinformationen und Empfehlungen zusammen. Bei leichteren Verlaufen reicht meist die Behandlung durch den Hausarzt mit Erarbeiten eines biopsychosozialen Erklarungsmodells und korperlicher/sozialer Aktivierung. Schwerere Verlaufe bedurfen eines kooperativen, koordinierten Vorgehens mit regelmasigen/beschwerdeunabhangigen Terminen beim Hausarzt, gestufter Aktivierung und Psychotherapie – v. a. kognitiv-behaviorale, daneben psychodynamisch-interpersonelle und hypnotherapeutische/imaginative. Besonders schwere Verlaufe erfordern eine multimodale, ggf. (teil-)stationare Therapie. Erganzend wird die fur Betroffene und ihre Angehorigen erarbeitete Patientenleitlinie vorgestellt.

Background: Somatic symptom disorder (SSD) is a diagnosis that was newly included in DSM-5 . Currently, data on the course of SSD is largely lacking. The present study aimed to evaluate the natural course of SSD in a one-year follow-up study in patients with vertigo and dizziness (VD) symptoms. Methods: We investigated n =239 outpatients presenting in a tertiary care neurological setting over a one-year period. Patients had a medical examination at baseline and completed self-report questionnaires, which were re-assessed after 12months. DSM-5 SSD was assigned retrospectively. We evaluated the prevalence of SSD at baseline and 12- month follow-up and investigated predictors of the persistence of SSD during the study period. Results: The prevalence rate of SSD was 36% at baseline and 62% at 12-months follow-up. The persistence rate of SSD was 82% and the incidence rate was high, leading to a markedly increased prevalence rate at follow-up. Risk factors for persistent SSD were a self-concept of bodily weakness (OR: 1.52, 95% CI: 1.30–1.78) and an increase of depression during the study period (OR: 1.11, 95% CI: 1.02–1.22). Further, the diagnosis of an anxiety disorder (OR: 7.52, 95% CI: 1.17–48.23) or both anxiety and depressive disorder (OR: 23.14, 95% CI: 2.14–249.91) at baseline were significant predictors. Conclusions: Our findings point out that SSD is highly prevalent in patients with VD symptoms, and the incidence of the disorder widely outweighs its remission. Potential predictors of a persistence of SSD are discussed and can be chosen as a focus in therapy.