What attitude towards a patient with somatoform disorder?

The diagnosis of a somatic symptom disorder must be based on both a negative approach - eliminating another psychiatric or non-psychiatric disorder that would better explain the symptoms - and a positive one, which is, based on the search for characteristic thoughts, emotions or behaviours as well as biological or psychological factors that may promote, trigger or sustain the disorder. Additional tests and specialized medical consultations should not be prescribed solely to reassure the patient; they may actually worsen the condition. The management will move away from the outdated notion of "medically unexplained symptoms" to rely on: the acknowledgment of the painful, debilitating and involuntary nature of the symptoms; the proposal of a positive diagnosis acceptable by the patient and an explanatory model compatible with his or her representations, aimed at putting an end to dysfunctional health care utilization; the proposal of therapeutic objectives aimed at functional rather than symptomatic recovery; the negotiation of pharmacological (selective or mixed serotonin reuptake inhibitor if necessary) and non-pharmacological interventions, especially when it comes to limiting the factors that sustain the disorder; the coordination of the various healthcare professionals.
Competing Interests: C. Lemogne déclare des liens ponctuels (activités de conseil et conférences) avec Lundbeck et Janssen. V. Pitron et J.-Y. Rotgé déclarent n’avoir aucun lien d’intérêts. F. Limosin déclare des interventions ponctuelles pour Euthérapie/Servier, Janssen, Lundbeck, Otsuka et Roche. P. Cathébras déclare des liens ponctuels avec MSD (conférences, colloques, actions de formation) et LFB (prise en charge lors de congrès).