[Somatoform and factitious disorders in clinical medicine]

Patients with "medically unexplained somatic symptoms" are frequent in every health care system. The bodily complaints may persist over a long period of time, cause serious subjective suffering and be associated with secondary psychiatric comorbidity and major disabilities in psychosocial life. The doctor-patient relationship is often hampered by emotional conflicts, leading to unsuccessful treatment, doctor-shopping and chronic courses of illness. A major subgroup of patients with somatoform disorders and a minor subgroup of patients with self-induced, i.e., factitious disorders must be differentiated, both showing a complex etiopathogenesis of their somatic symptoms. Patients with somatoform and factitious disorders present a special challenge within the health care system.