The Interface Between Physical and Psychological Symptoms

Somatic symptoms account for over half of all primary care visits and are often medically unexplained as well as chronic or recurrent. Unexplained, persistent, or multiple somatic symptoms are frequently a marker for an underlying depressive or anxiety disorder. Certain clinical predictors increase the likelihood of psychiatric comorbidity and should trigger earlier screening and intervention. Both antidepressants as well as nonpharmacologic psychological treatments have proven effective for treatment of individual somatic symptoms as well as functional syndromes such as irritable bowel syndrome, fibromyalgia, migraine headache, and other pain disorders. A stepped care approach is described, which may be useful in the care of patients with somatic symptoms. When somatic and psychological symptoms coexist, treatment of both is necessary to optimize clinical outcomes.