Psychoanalytically-oriented inpatient psychotherapy of somatoform disorders

Somatoform disorders have been neglected in psychoanalytic publications. Unlike the descriptive approach of DSM-IV and ICD-10, sophisticated psychoanalytical models have been proposed for many years explaining the development of physical symptoms without definable medical cause. Based on a review of the psychoanalytic models of somatization and conversion, this article explores difficulties in the medical and psychotherapeutic treatments of somatoform disorders. The unique tradition of psychosomatic inpatient treatment in Germany is illustrated by the psychoanalytic treatment setting at the University of Mainz. A case report of a somatoform patient shows how childhood trauma is activated and integrated in the course of inpatient treatment. In a multimodal approach, psychoanalytic individual and group therapy may interact beneficially with body-oriented, art therapy, and other treatment elements to gain therapeutic access to chronic somatoform patients, activate and work through trauma and conflict. Regardless of the specific setting, analytic treatments need to do justice to the specific deficits (e.g., symbolization of affect, mentalization) and defences of somatoform patients.