Somatoform disorders F45 x

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 19.10.2023

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Body dysmorphic disorders; disorders, somatoform; Disturbances body dysmorphic; Somatoform disorders; Somatoformer Itching; Somtatoform disorders

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Somatoform disorders (in dermatology) refer to physical complaints that cannot be attributed, or not sufficiently attributed, to a genuine dermatological disease. In addition to indefinable skin symptoms, general symptoms such as fatigue and exhaustion, pain symptoms, cardiovascular complaints, gastrointestinal complaints, sexual and pseudoneurological symptoms are in the foreground. Somatoform disorders should be distinguished from psychological disorders (especially depressive disorders, anxiety disorders and personality disorders).

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Transient somatoform disorders occur in about 80% (!) of the population. In 4-20% these complaints can become chronic. Somatoform disorders belong to the frequent dermatological disorders (about 18% of a general dermatological clientele; in comparison with general practitioners: about 20% of patients). The costs for the treatment of this group of persons are considerable and are up to 14 times higher than the average per capita treatment expenditure!

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An interplay of various biological, psychological and social factors is assumed. Genetic factors are discussed.

Clinical features
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Among dermatological clients, pruritus, somatoform autonomic dysfunctions such as erythrophobia or hyperhidrosis, anogenital pain syndromes or dysesthesias (e.g. Vulvodynia, Glossodynia), feelings of disfigurement ( Dysmorphophobia) with its special form the " Dorian-Gray-Syndrome" or also not objectifiable hair loss (see below Effluvium) in the foreground of an insistent, by the patient vehement or larmoyant presented symptomatology of complaints.

Hypochondriacal disorders such as carcinophobia or phobia of infections (e.g. borrelia phobia or mycophobia) also come to the fore.

In the past, venereal diseases were more in the focus of the symptomatology of complaints.

Likewise, complaints are made of incomprehensible allergological symptomatology (e.g., amalgam allergy, allergies to detergents) or of general hypersensitivity (see Multiple ChemicalSensitivity/Ecosyndrome or Sensitive Skin Syndrome). Also reported are feelings of respiratory inhibition, pressure sensations, stitches, chest tightness, heart palpitations, irritable stomach and intestines with nausea, bloating, abdominal pain, stool irregularities, chronic lower abdominal pain, urethral syndrome, prostatic dynia.

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By excluding organic causes of the complaints complained of. It is important to make a psychological diagnosis taking into account current affects, psychological conflicts as well as social and cultural factors.

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Establishing a sustainable relationship of trust between doctor (psychotherapist) and patient. Patients' complaints must be taken seriously, but should not be exacerbated by overdiagnosis, which can trigger new fears. A relaxation method such as autogenic training or progressive muscle relaxation according to Jacobson can be very helpful. Physiotherapeutic and body-therapeutic measures such as physiotherapy, functional relaxation, dance therapy etc. can often significantly alleviate the symptoms. Psychotherapeutic treatment is necessary in case of persistent stress situations or mental conflicts that cannot be solved by oneself.

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Somatoform disorder

Dermatological clinical pictures


Somatisation Disorder

Environmental syndromes(eco-syndrome; sensitivity, multiple, chemical = MCS)

Special forms: "amalgam allergy", "light allergy", food intolerances, "sperm allergy", "detergent allergy

F 45.2

Hypochondriac disorders

Nosophobias (carcinophobia, infection phobia [e.g. Borrelia phobia])

Body dysmorphic disorders (ugliness complex, Dorian Gray syndrome)

F 45.3

Somatoform autonomic dysfunctions

Erythrophobia, Hyperhidrosis

F 45.4

Persistent somatoform pain disorders

Cutaneous dysesthesias(glossodynia, trichodynia, vulvodynia)


Other somatoform disorders

Sensory complaints(pruritus on primarily unchanged skin, tingling, pricking); Tanorexia

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The term "somatoform disorders" was introduced into the official classification systems in 1980. In the International Classification of Diseases (ICD-10), they are included in category F45. Traditional terms for clinical pictures from these categories are e.g. psychogenic disorders, functional disorders, vegetative dystonia, general psychosomatic syndrome, conversion hysteria, Briquet hysteria, psychic overlay, neurasthenia, nihiloderma, "dermatologic non-disease".

The relationship between doctors and patients with somatoform disorders is often extremely difficult: there is a risk of breaking off the doctor-patient relationship and frequent changes of doctor ("doctor-hopping" or "doctor-shopping"). The patient, despite comprehensive medical information, continues to accept organic causes of his complaints (only these legitimize his complaints) and does not feel taken seriously by the doctor.

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  1. Brähler E et al (2002) Findings and health: psychological aspects of physical complaints. In: Brähler E, Strauß B (ed.) Fields of action in psychosocial medicine. Hogrefe, Göttingen
  2. Harth W et al (2007) Nihiloderma in psychodermatology. Dermatologist 58: 427-434
  3. Stand S (2018) Pruritus and Prurigo. In: G.Plewig et al. (eds.), Braun-Falco`s Dermatology, Venerology and Allergology. Springer Reference Medicine S 589


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Last updated on: 19.10.2023