[Functional physical complaints. Guideline for diagnosis and treatment of somatoform disorders]

Although physical symptoms are the main reason why people go to the doctor, in many cases no unequivocal underlying organic disturbances are to be found, not even during subsequent visits to the doctor (Kroenke & Mangelsdorff, 1989). Frequently, the patient's previous history contains pointers for other physical complaints that also had no unequivocal organic etiology. This group of patients, who often present their problem in a very complaining fashion, are considered by many physicians to be difficult, bothersome, and ungrateful. Until quite recently it was assumed that the chances of successful treatment in these patients were poor. Accordingly, an American standard textbook of psychiatry recommends, as the main aim of the treatment, avoiding iatrogenic harm (Barsky, 1988). The present article wishes to make it clear that such a pessimistic assessment of the therapeutic outcome is no longer warranted. A positive effect can now be achieved with ambulatory psychotherapeutic measures both in the offices of general practitioners or internists, and in hospitals offering integrative-psychosomatic treatment on an inpatient basis.