Specific Treatment Approaches for Somatization Disorder

Specific treatment approaches have not been well studied in somatization disorder or undifferentiated somatoform disorder. However, several studies have provided preliminary evidence that cognitive-behavioral therapy may be effective in patients with medically unexplained symptoms and that group treatment using similar approaches may be effective. In addition, substantial literature recommends specific treatment for these disorders.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy has been advocated for patients with multiple unexplained somatic symptoms. Speckens et al. reported the results of a randomized controlled trial that found that primary care patients with medically unexplained symptoms had a decrease in the intensity and number of symptoms, an improvement in functioning, and a decrease in illness behavior after cognitive-behavioral therapy. The cognitive-behavioral intervention was delivered in the primary care setting with the encouragement of the primary care physician. The mean number of sessions was 12 delivered over 8 weeks. Although these patients did not specifically have somatization disorder or undifferentiated somatoform disorder, the group certainly contained several patients with these disorders.

Group Treatment
Several authors, giving relatively uniform recommendations, have indicated that group treatment may be beneficial for patients with somatization disorder. Most of these authors recommend directed, time-limited group therapy with an emphasis on ways to improve patients' socialization and coping skills. Such therapy groups usually are conducted by nonphysician mental health professionals.

The results of Kashner et al.'s randomized controlled study indicated that short-term, time-limited, cognitive-behavioral group therapy is cost-effective for patients with somatization disorder and improves their health status. Patients who received this type of group treatment reported significantly better physical and mental health than did patients who did not receive the group therapy. Also, a 52% net savings in health care charges was associated with the group treatment. Both the process and the content of the group intervention were tailored to address the overall goals of patients' developing a source of peer support, sharing methods of coping with physical problems, and increasing their ability to perceive and express emotion; in addition, the group provided an enjoyable experience for the participants. To simulate a classroom atmosphere, each meeting began with a didactic presentation of the selected topic (see description of topics below), followed by a small group discussion to facilitate peer communication. Group members next participated in an exercise to increase group cohesiveness, to develop personal feelings of competence, and to reinforce their ability to take risks. This therapeutic exercise was then discussed by the group, with an emphasis on feelings during the activity, humor, and self-expression. The sessions closed with a presentation of the next meeting's subject, the appointment of two group members to facilitate during the next session, and a "brag" session for group members to make and receive positive statements about themselves. The focus of each session was as follows: