[Psychotherapy of somatoform pain disorders in the elderly]

This article focuses on somatoform pain disorders in elderly patients. Defined as a variant of the somatoform disorders, somatoform pain represents a disorder characterized by significant, physically experienced pain that is not (fully) explained by a medical condition. Although epidemiological data are sparse, the prevalence of somatoform pain disorders appears to decline with aging. Psychological factors are assumed to have an important role in the onset, severity, and maintenance of somatoform pain. In this article, two case reports are presented in order to illustrate the phenomenon that earlier pain experiences, e.g., in the context of a physical disorder or in the context of traumatic events, may "pave the way" for somatoform pain syndromes. Later acute mental stress or psychological conflicts may then precipitate the onset of somatoform pain. With respect to therapy, one should consider that patients with somatoform pain experience and interprete their suffering as a physical disorder. When applying psychotherapy to patients with somatoform pain disorders the therapist has to recognize and to appreciate eventual previous pain experiences which may have "paved the way" for the present disorder. Only after having established a therapeutic relationship can one try to interest the patient in the individual emotional and cognitive aspects that may underly the disorder. In addition to depressive feelings and feelings of guilt, grief about the loss of bodily functions may be of special significance for the onset and maintenance of somatoform pain disorders in elderly persons.