Skip to main content
SpringerLink
Log in

Somatoforme Störungen mit Leitsymptom Schmerz

Ergebnisse zur Differenzierung einer häufigen Krankheitsgruppe

Somatoform disorders with pain as the predominant symptom

Results to distinguish a common group of diseases

  • Originalien
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Somatoforme Schmerzstörungen gehören nach Untersuchungen in der deutschen Allgemeinbevölkerung mit einer 1-Jahres-Prävalenz von 8% und einer Lebenszeitprävalenz von 12,7% zu den häufigsten psychischen Störungen. Bisher gibt es kaum Studien zu einer genaueren Charakterisierung und Differenzierung dieses Störungsbildes. In der vorliegenden Untersuchung wird erstmals eine große Patientenstichprobe einer Universitätspoliklinik mit somatoformer Störung und Leitsymptom Schmerz (N=282), bei denen durch fachübergreifende Diagnostik eine peripher nozizeptive oder neuropathische Schmerzgenese ausgeschlossen werden konnte, hinsichtlich einer komorbiden psychischen Störung sowie der Symptompräsentation weiter differenziert. Bei allen wurden strukturierte Interviews zur Erfassung psychischer Störungen (SKID-I und SKID-II) sowie eine strukturierte biografische Anamnese (MSBI) zur Erhebung von Belastungs- und Chronifizierungsparametern durchgeführt. Mithilfe des Screenings für somatoforme Störungen (SOMS) wurden Ausmaß und Verteilung somatisierter körperlicher Beschwerden erfasst: 69% der Untersuchten leiden unter mindestens einer weiteren psychischen Störung, v. a. Angsterkrankungen und depressiven Störungen; nur bei 14% besteht komorbide eine Persönlichkeitsstörung. Mehr als 90% geben neben Schmerzen weitere somatisierte körperliche Beschwerden an. Das Vorhandensein einer komorbiden psychischen Störung sowie die Beschwerdedauer sind mit einer höheren Anzahl körperlicher Beschwerden verbunden, wegen denen sie sich ebenfalls in ärztliche Behandlung begeben könnten (z. B. Müdigkeit, Schwindel). Auch die Häufigkeit der „Diagnose“ Fibromyalgie steigt mit dem Ausmaß der Somatisierung. Die vorliegenden Ergebnisse unterstützen letztlich, diese Patientengruppe als eigenständige diagnostische Kategorie beizubehalten. Sie legen eine künftige Differenzierung hinsichtlich des Schweregrades – ähnlich wie bei depressiven Störungen – nahe.

Abstract

According to a population-based prevalence study, medically unexplained pain syndromes are highly prevalent in the German general population. With a 1-year prevalence of 8% for somatoform pain disorders and a lifetime prevalence of 12.7%, they rank among the most prevalent conditions in the community. Until now, few studies have been conducted to characterize and differentiate patients with somatoform pain disorders in more detail. The present study is the first to examine a large patient cohort from a university hospital outpatient unit with somatoform disorders presenting with pain as the predominant complaint (n=282). Patients with a nociceptive or neuropathic pain mechanism were excluded after interdisciplinary diagnostic procedures, and all patients were differentiated in terms of comorbid psychic disorders and their symptom presentation. Psychic disorders were assessed using a standardized structured interview (SCID-I and SCID-II) and a structured biographical case history (MSBI) to assess chronification factors. The extent and distribution of bodily symptoms were collected using the screening for somatoform disorders (SOMS). A total of 69% of the patients examined suffered from anxiety and depressive disorders or other mental disorders, and only 14% had a comorbid personality disorder. More than 90% had further bodily symptoms apart from pain. The presence of mental disorders and the duration of the illness were associated with a higher number of bodily symptoms (e.g., fatigue, dizziness), for which they may also consult a doctor. In addition, the frequency of fibromyalgia syndrome increases with the extent of somatization. Our results ultimately support the idea of classifying this group of patients as an independent diagnostic group. They further suggest a future differentiation regarding the degree of impairment within this group similar to the systems of stages used in depressive disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Arnold IA, de Waal MW, Eekhof JA, van Hemert AM (2006) Somatoform disorder in primary care: course and the need for cognitive-behavioral treatment. Psychosomatics 47:498–503

    Article  PubMed  Google Scholar 

  2. Arnold BS, Alpers GW, Suss H et al (2008) Affective pain modulation in fibromyalgia, somatoform pain disorder, back pain, and healthy controls. Eur J Pain 12:329–338

    Article  PubMed  Google Scholar 

  3. Creed F (2006) Should general psychiatry ignore somatization and hypochondriasis? World Psychiatry 5:146–150

    PubMed  Google Scholar 

  4. Dimsdale JE, Dantzer (2007) A biological substrate for somatoform disorders: importance of pathophysiology. Psychosom Med 69:850–854

    Article  PubMed  Google Scholar 

  5. Egle UT, Ecker-Egle ML, Nickel R, van Houdenhove B (2004) Fibromyalgie als Störung der zentralen Schmerz- und Stressverarbeitung. Ein neues biopsychosoziales Krankheitsmodell. Psychother Psychosom Med Psychol 54:137–147

    Article  PubMed  Google Scholar 

  6. Egle UT, Hardt J (2004) Mainzer Strukturiertes Biographisches Interview. In: Strauß B, Schumacher J (Hrsg) Klinische Interviews und Ratingskalen. Diagnostik für Klinik und Praxis. Hogrefe, Göttingen, S 261–265

  7. Egle UT, Nickel R (2008) Chronischer Rückenschmerz als somatoforme Schmerzstörung. Orthopäde 37:280–284

    Article  PubMed  CAS  Google Scholar 

  8. Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989) Somatic Symptom Index (SSI) a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis 177:140–146

    Article  PubMed  CAS  Google Scholar 

  9. Escobar JI, Waitzkin H, Silver RC et al (1998) Abridged somatization: a study in primary care. Psychosom Med 60:466–472

    PubMed  CAS  Google Scholar 

  10. Fava GA, Wise TN (2007) Issues for DSM-V: psychological factors affecting either identified or feared medical conditions: a solution for somatoform disorders. Am J Psychiatry 164:1002–1003

    Article  PubMed  Google Scholar 

  11. Fink P, Hansen MS, Oxhoj ML (2004) The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 56:413–418

    Article  PubMed  Google Scholar 

  12. Fröhlich C, Jacobi F, Wittchen H-U (2006) DSM-IV pain disorder in the general population. An exploration of the structure and threshold of medically unexplained pain symptoms. Eur Arch Psychiatry Clin Neurosci 256:187–196

    Article  PubMed  Google Scholar 

  13. Gündel H, Valet M, Sorg C et al (2008) Altered cerebral response to noxious heat stimulation in patients with somatoform pain disorder. Pain 137:413–421

    Article  PubMed  Google Scholar 

  14. Harris A, Orav EJ, Bates DW, Barsky AJ (2008) Somatization increases disability independent of comorbidity. J Gen Intern Med (Epub ahead of print)

  15. Hessel A, Geyer M, Schumacher J, Brähler E (2002) Somatoforme Beschwerden in der Bevölkerung Deutschlands. Z Psychosom Med Psychother 48:38–58

    PubMed  Google Scholar 

  16. Hessel A, Geyer M, Hinz A, Brahler E (2005) Inanspruchname des Gesundheitssystems wegen somatoformer Beschwerden – Ergebnisse einer bevölkerungsrepräsentativen Befragung. Z Psychosom Med Psychother 51:38–56

    PubMed  Google Scholar 

  17. Hiller W, Fichter MM, Rief W (2003) A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness. J Psychosom Res 54:369–380

    Article  PubMed  Google Scholar 

  18. Hoffmann C, Ruf-Ballauf W (2007) Stationäre psychosomatische Rehabilitation bei Patienten mit somatoformen Störungen sowie Patienten mit sozialmedizinisch relevanten Problemen: Ergebnisse einer Zweijahreskatamnese. Rehabil 46:283–295

    Article  CAS  Google Scholar 

  19. Imbierowicz K, Egle UT (2003) Childhood adversities in patients with fibromyalgia and somatoform pain disorder. Eur J Pain 7:113–119

    Article  PubMed  Google Scholar 

  20. Jackson JL, Kroenke K (2008) Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study. Psychosom Med 70:430–434

    Article  PubMed  Google Scholar 

  21. Jacobi J, Wittchen H-U, Hötling C et al (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS) Psychol Med 34:597–611

    Google Scholar 

  22. Kellner R (1994) Psychosomatic syndromes, somatization and somatoform disorders. Psychother Psychosom 61:4–24

    Article  PubMed  CAS  Google Scholar 

  23. Kivimäki M, Leino-Arjas P, Virtanen M et al (2004) Work stress and incidence of newly diagnosed fibromyalgia: prospective cohort study. J Psychosom Res 57:417–422

    PubMed  Google Scholar 

  24. Kroenke K, Spitzer RL, deGruy FV et al (1997) Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry 54:352–358

    PubMed  CAS  Google Scholar 

  25. Kroenke K, Sharpe M, Sykes R (2007) Revising the classification of somatoform disorders: key questions and preliminary recommendations. Psychosomatics 48:277–285

    Article  PubMed  Google Scholar 

  26. Lieb R, Meinlschmidt G, Araya R (2007) Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: an update. Psychosom Med 69:860–863

    Article  PubMed  Google Scholar 

  27. Löwe B, Mundt C, Herzog W et al (2008) Validity of current somatoform disorder diagnoses: perspectives for classification in DSM-V and ICD-11. Psychopathology 41:4–9

    Article  PubMed  Google Scholar 

  28. Maaranen P, Tanskanen A, Haatainen K et al (2004) Somatoform dissociation and adverse childhood experiences in the general population. J Nerv Ment Dis 192:337–342

    Article  PubMed  Google Scholar 

  29. Mayou R, Kirmayer LJ, Simon G et al (2005) Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 162:847–855

    Article  PubMed  Google Scholar 

  30. Mussel M, Kroenke K, Spitzer RL et al (2008) Gastrointestinal symptoms in primary care: prevalence and association with depression and anxiety. J Psychosom Res 64:605–612

    Article  Google Scholar 

  31. Nilsen KB, Westgaard RH, Stovner LJ et al (2006) Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography. Eur J Pain 10:615–627

    Article  PubMed  CAS  Google Scholar 

  32. Price DD (2000) Psychological and neural mechanisms of the affective dimension of pain. Science 288:1769–1772

    Article  PubMed  CAS  Google Scholar 

  33. Rief W, Hiller W (1997) SOMS – Das Screening für Somatoforme Störungen. Manual zum Fragebogen. Hans Huber, Bern

  34. Rief W, Hiller W (2003) A new approach to the assessment of the treatment effects of somatoform disorders. Psychosomatics 44(6):492–498

    Article  PubMed  Google Scholar 

  35. Rief W, Rojas G (2007) Stability of somatoform symptoms – implications for classification. Psychosom Med 69(9):864–869

    Article  PubMed  Google Scholar 

  36. Rief W, Treede R-D, Schweiger U et al (2009) Neue Schmerzdiagnose in der deutschen ICD-10-Version. Nervenarzt (Epub ahead of print)

  37. Sommer C, Häuser W, Gerhold K et al (2008) Ätiopathogenese und Pathophysiologie des Fibromyalgiesyndroms und chronischer Schmerzen in mehreren Körperregionen. Schmerz 22:267–282

    Article  PubMed  CAS  Google Scholar 

  38. Starcevic V (2006) Somatoform disorders and DSM-V: conceptual and political issues in the debate. Psychosomatics 47:277–281

    Article  PubMed  Google Scholar 

  39. Stoeter P, Bauermann T, Nickel R et al (2007) Cerebral activation in patients with somatoform pain disorder exposed to pain and stress: An fMRI study. Neuroimage 36:418–430

    Article  PubMed  CAS  Google Scholar 

  40. Toft T, Fink P, Oernboel E et al (2005) Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary Care (FIP) Study. Psychol Med 35:1175–1184

    Article  PubMed  Google Scholar 

  41. Valet M, Gündel H, Sprenger T et al (2009) Patients with pain disorder show gray-matter loss in pain-processing structures: a voxel-based morphometric study. Psychosom Med 70 (Epub ahead of print)

  42. Wager TD, Rilling JK, Smith EE et al (2004) Placebo-induced changes in FMRI in the anticipation and experience of pain. Science 303:1162–1167

    Article  PubMed  CAS  Google Scholar 

  43. Wager TD, Scott DJ, Zubieta JK (2007) Placebo effects on human -opioid activity during pain. PNAS 104:11056–11061

    Article  PubMed  CAS  Google Scholar 

  44. Wittchen HU, Zaudig M, Fydrich T (1997) SKID. Strukturiertes Klinisches Interview für DSM-IV. Göttingen, Hogrefe

  45. Wolfe F, Hawley DJ (1998) Psychosocial factors and the fibromyalgia syndrome. Z Rheumatol 57(Suppl 2):88–91

    Article  PubMed  Google Scholar 

  46. Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumtology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

  47. Yunus MB (2008) Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum 37:339–352

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Psychosomatische Medizin und Psychotherapie , Dr. Horst Schmidt Klinik Wiesbaden, Rheingauer Straße 35, 65388, Schlangenbad, Deutschland

    R. Nickel

  2. Medizinische Psychologie und Medizinische Soziologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    J. Hardt

  3. Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    B. Kappis & R. Schwab

  4. Psychosomatische Fachklinik Gengenbach., Gengenbach, Deutschland

    U.T. Egle

Authors
  1. R. Nickel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Hardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Kappis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Schwab
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U.T. Egle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Nickel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nickel, R., Hardt, J., Kappis, B. et al. Somatoforme Störungen mit Leitsymptom Schmerz. Schmerz 23, 392–398 (2009). https://doi.org/10.1007/s00482-009-0805-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-009-0805-6

Schlüsselwörter

Keywords

Search

Navigation