Functional somatic syndromes and bodily distress - guideline-based management

Abstract

Summary Functional somatic syndromes and bodily distress – guideline-based management Functional somatic symptoms (FSS) result from mostly acquired, potentially reversible disturbances in the organism’s various functions, not in structures. They originate from dysfunctions in the complex interplay of biological, psychological and sociocultural factors. They are very common and often mild and transient. In about every third patient, however, they are associated with significant impairment of functioning and quality of life, and thus with high level of suffering and costs. This narrative review is based on a current AWMF-S3 guideline and a selective literature search. It discusses the new FSS conceptual-isations and summarises useful management strategies for FSS in adults, in all medical settings and all levels of severity. Due to new scientific insights, our understanding of FSS changed in recent years. As a consequence, the former classification of FSS as somatoform disorders has been largely revised. The new concepts of somatic symptom cisorder in DSM-5 and bodily distress disorder in ICD-11 emphasise the stress caused by, and also causing, somatic disorder symptoms, regardless of their aetiology. They abandon the former requirement of excluded organic causes and introduce psychobehavioural criteria that can be addressed in therapy. In a severity-graded, collaborative care model, basic care is about recognising FSS and comorbidities, reassuring and advising in terms of a healthy, active lifestyle, and watchful waiting. Persistent and distressing symptoms need an extension of care, with a clear setting, regular appointments and broader, simultaneous biopsychosocial diagnostics, resulting in an individualised biopsychosocial explanatory model. From this model, appropriate coping strategies such as attentional diversion and graded exercise are derived, which aim to improve well-being and function. In more severe courses, multimodal treatment is recommended, adding disorder-oriented psychotherapy and physiotherapy, and appropriate body-therapeutic and rehabilitative measures.