Somatoform and Neurotic Disorders in General Medical Practice: The Clinical and Psychological Patient Profile

Abstract

Aim : To develop a clinical and psychological profile of treatment-adherent patients with somatoform disorders (SFD) in general medical practice by analyzing their diagnostic pathway and its association with cognitive-affective features. Materials and methods : A retrospective observational cohort study was conducted. From 350 patients with polymorphic somatic complaints, a cohort with verified ICD-10 F45 diagnoses was formed (n=261). An in-depth retrospective analysis (n=192) included a clinical interview, review of medical records, the Hospital Anxiety and Depression Scale (HADS), the Numeric Rating Scale (NRS-10), and qualitative assessment of alexithymia, catastrophizing, and health locus of control. Results : In the in-depth analysis subgroup, women predominated (87.2%), median age was 42 years, and median symptom duration before psychiatric referral was 5.2 years. Subjective symptom severity on NRS-10 reached 8 [7–9]. Median HADS-A score was 8 [6–11] and median HADS-D score was 4 [2–7]. A previous diagnosis of “vegetative-vascular dystonia” had been established in the somatic network in 71.8% of patients. Catastrophizing was identified in 79.5% and an external health locus of control in 89.7% of patients. Among 113 patients lost to follow-up, the main reasons were refusal to accept the psychogenic nature of their somatovegetative symptoms (n=40), low adherence (n=32), and difficulties in establishing a therapeutic alliance (n=41), against the background of fears of stigmatization and restriction of rights as a consequence of psychiatric treatment. External locus of control was significantly associated with a longer diagnostic pathway (p<0.01). In the studied cohort, 71.8% of SFD patients had comorbid anxiety disorders (F41). Conclusion : In the studied SFD cohort, selected without excluding anxiety disorders, the diagnoses of “VVD” and functional gastrointestinal disorders frequently co-occurred with SFD and comorbid anxiety pathology. External health locus of control was associated with delayed psychiatric referral. The obtained profile characterizes a subpopulation of patients who reached a psychiatrist and were adherent to treatment; catastrophizing and external locus of control remain key screening targets in this group.