Somatoforme Störungen: Verhaltensmedizinisches Störungsmodell, Diagnostik und Intervention

Subtitle: Somatoform disorders in childhood and adolescence: Aetiology, assessment and intervention from the perspective of behavioural medicine

Article type: Research Article

Authors: Noeker, Meinolf

Affiliations: Psychologischer Psychotherapeut für Kinder, Jugendliche und Erwachsene, LWL-Dezernent für Krankenhäuser und Gesundheitswesen Landschaftsverband Westfalen-Lippe, Hörsterplatz 2, Münster. Tel.: 0251/591-230; E-mail: meinolf.noeker@lwl.org

Abstract: One third of all children and adolescents among the population suffer from functional symptoms and pain disorders (including abdominal pain, headache, joint pain) without diagnosable biomedical correlate. A subgroup does not achieve a successful adaptation to these functional symptoms but develops a somatoform disorder that is associated with an excessive medical consultation behavior, hypochondriacal anxiety and significant psychosocial impairment (e.g. school absenteeism). This paper presents a behavioral medicine conceptualization of the emergence of somatoform disorder, an approach to assessment and case formulation, and a behavioral medicine intervention comprising seven modules based on an individually tailored treatment indication. (1) Biopsychosocial conceptualization. It consists of a two-phase model that identifies the relevant factors and pathways contributing to the transition from functional symptoms to the emergence of a somatoform disorder. In terms of a theory-based intervention planning, the factors involved act as targets both for assessment and intervention. (2) Assessment strategies comprise patient and family history as well as a functional behavior analysis concerning the child's and the parents' cognition, emotion and behavior in critical episodes of symptomatic manifestation. In addition, rating scales, questionnaires and symptom diaries addressing frequency, intensity and spectrum of functional symptoms and pain as well as their management are administered. (3) Intervention. Diagnostic information and informed consent on treatment goals and setting determine an individualized treatment plan that may comprise seven major treatment modules: (1) pediatric therapy, (2) explaining the diagnosis of a benign functional disorder and patient education, (3) behavioral medicine strategies of pain and symptom relief (attention control, relaxation techniques, self-instruction), (4) cognitive restructuring of distorted, hypochondriac pain information processing, (5) control of precipitating, symptom-inducing stress factors, (6) modification of the parental response to pain communication of the child, (7) strengthening social integration into peer group and school. The empirical evaluation of behavioral medicine intervention programs is just beginning. Pilot studies in the field of functional gastrointestional disorders show a high efficacy of cognitive behavioral approaches which has already led to their implementation into national and international treatment guidelines.

Keywords: Somatoform disorder, functional symptoms, adaptation, behavioral medicin

DOI: 10.3233/ZMP-2012-210012

Journal: Zeitschrift für Medizinische Psychologie, vol. 21, no. 3, pp. 100-111, 2012