A network for students interested in evidence-based health care

Unexplained symptoms: somatoform disorders

Posted on 13th July 2015 by

Evidence Reviews
puzzled doctor

The issue

It never is easy when you feel something is wrong but don’t know what it is, so if you’re a patient you’ll visit the doctor. The real question is; what if even your doctor doesn’t know the cause of your symptoms?

These medically unexplained physical symptoms have been grouped together and given a name (as those in the medical profession do; give big, fancy names to this, that or the other) they’ve been called ‘Somatoform disorders’.

Somatoform disorders have a number of different types and diagnosis guidelines and are NOT the same as malingering, nor the same as physical symptoms of psychiatric disorders.

These unexplained symptoms range from pain, to vomiting, to seizures and are, as I’m sure you’d expect, the cause of considerable pain and suffering for patients and family members and the cause of much confusion for healthcare professionals who can’t figure out what’s wrong or how to treat.

Another name for these disorders is functional disorders; the older ‘Somatoform’ term is starting to go out of fashion.

The prevalence

Something like 1 in 3 people go to the doctor with symptoms that simply have no explanation; from digestive problems to sexual problems, and sometimes even with symptoms like memory loss and sensory loss, only to find the doctor is as confused as they are. A large number of these symptoms persist and 6 in 100 people suffer from them long-term.

Females of lower socioeconomic standing are more likely to develop such disorders but that is almost as far as you’ll get looking for risk factors that apply to all the Somatoform disorders.

The solution

Current guidelines recommend talking therapy alongside medication and many patients are treated with anxiety and depression medication based on NO evidence.

Cochrane has come to the rescue with two new systematic reviews on this subject under the titles of:

Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults


Pharmacological interventions for somatoform disorders in adults

Well these two reviews looked at the pharmacological and non-pharmacological interventions available for Somatoform disorders and came to the conclusion that:

  • New-generation antidepressants were used to successfully treat physical symptoms and anxiety witnessed in somatoform disorders.
  • Natural remedies like St. John’s wort, managed to make the symptoms less severe. It was noted however that more people left the study on antidepressants than those on natural remedies stating that side effects or not noticing any improvement for the better on antidepressants.
  • Like natural remedies, cognitive behaviour therapy,  a type of talk therapy, was able to reduce how severe the symptoms were, better than normal care but not better than enhanced care provided by the doctor.

Not sure how willing patients will be to undergo therapy for physical symptoms though.

The future

Well the quality of the evidence meant that a lot of the treatments were actually studied but nothing concrete could be concluded other than the above. That is NOT to say that all the treatments missing from here are not effective. But that these reviews weren’t able to conclude anything else based on the evidence they had available.

More research is needed into this disorder. It might also be that doctors should take these symptoms more seriously and provide optimal care for their patients which has been proved (as above) to be of better effect than traditional treatment.


van Dessel N, den Boeft M, van der Wouden JC, Kleinstäuber M, Leone SS, Terluin B, Numans ME, van der Horst HE, van Marwijk H. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD011142. DOI: 10.1002/14651858.CD011142.pub2.

Kleinstäuber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacological interventions for somatoform disorders in adults. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010628. DOI: 10.1002/14651858.CD010628.pub2.

Creative Commons License
Unexplained symptoms: somatoform disorders by Ammar Sabouni is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Based on a work at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011142.pub2/abstract. All images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.


Ammar Sabouni

Hi! I'm Ammar! Originally from Syria, I'm quite interested in EBM, and I dabble a little in research; a very vague statement I know, well final year at medical school and still trying to figure out what it is I really like about all this. Add me and msg me, lets chat facebook.com/amm.sab twitter @amosabo View more posts from Ammar

Leave a Reply

Your email address will not be published. Required fields are marked *

No Comments on Unexplained symptoms: somatoform disorders

  • Dan Clarke

    “Not sure how willing patients will be to undergo therapy for physical symptoms though.”

    When it leads to only minor improvements in self-report measures in comparison to UC only? (And no improvement for any sort of active control).

    Not sure how willing patients will be to undergo homeopathy for physical symptoms either. Lot’s of people value their time more highly than that. I don’t think that similarly designed trials with similar results for homeopathy would have been presented so favourably as we see here for psychological therapy.

    13th July 2015 at 6:41 pm
    Reply to Dan

Subscribe to our newsletter

You will receive our monthly newsletter and free access to Trip Premium.