Somatising disorders: untangling the pathology

Somatising disorders are a common, complex and disabling cluster of disorders. Research suggests that general practitioners find this group of patients challenging. The disorders are complicated by the fact that doctors play a role in both their aetiology and maintenance. The interaction between the illness worry of the patient and the disease worry of the doctor can lead to escalating disability and the risk of iatrogenic disease.

In this article, common conceptual frameworks for somatising disorders are discussed and a framework for managing these complex disorders is presented.

Patients with somatising disorders need to establish a positive therapeutic relationship with their doctor that encourages open and honest discussion of their illness. General practitioners need to strike a balance between empathy for the patient's suffering and collusion in their disease worry. Excessive intervention and investigation should be avoided. This may require considerable professional support for the doctor.