Skip to main content

Are illness perceptions related to future healthcare expenditure in patients with somatoform disorders?

  • L. Frostholm (a1), K. J. Petrie (a2), E. Ørnbøl (a1) and P. Fink (a1)

Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients.


A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period.


Patients had more negative perceptions of their well-defined physical health problems when they had a co-morbid somatoform disorder. A strong illness identity [β = 0.120, 95% confidence interval (CI) 0.029–0.212, p = 0.012], perceived negative consequences (β = 0.010, 95% CI 0.001–0.019, p = 0.024), a long timeline perspective (β = 0.013, 95% CI 0.005–0.021, p = 0.001), low personal control (β = − 0.009, 95% CI –0.015 to −0.002, p = 0.011) and negative emotional representations (β = 0.009, 95% CI 0.002–0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders.


The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.

Corresponding author
* Address for correspondence: L. Frostholm, Ph.D., Clinical Associate Professor, Research Clinic for Functional Disorders, Aarhus University Hospital, Barthsgade 5.1, DK-8200 Aarhus N, Denmark. (Email:
Hide All
Cameron L, Leventhal EA, Leventhal H (1993). Symptom representations and affect as determinants of care seeking in a community-dwelling, adult sample population. Health Psychology 12, 171179.
Cheng C (2000). Seeking medical consultation: perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosomatic Medicine 62, 844852.
Creed F, Barsky A (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research 56, 391408.
Derogatis LR, Cleary PA (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology 33, 981989.
Dickson A, Toft A, O'Carroll RE (2009). Neuropsychological functioning, illness perception, mood and quality of life in chronic fatigue syndrome, autoimmune thyroid disease and healthy participants. Psychological Medicine 39, 15671576.
Efron B, Tibshirani R (2003). An Introduction to the Bootstrap. Chapman & Hall/CRC: New York.
Ewing J (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association 252, 19051907.
Fink P, Ewald H, Jensen J, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P (1999). Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. Journal of Psychosomatic Research 46, 261273.
Fink P, Ørnbøl E, Huyse FJ, de Jonge P, Lobo A, Herzog T, Slaets J, Arolt V, Cardoso G, Rigatelli M, Hansen MS (2004). A brief diagnostic screening instrument for mental disturbances in general medical wards. Journal of Psychosomatic Research 57, 1724.
Frostholm L, Fink P, Christensen KS, Toft T, Oernboel E, Olesen F, Weinman J (2005 a). The patients’ illness perceptions and the use of primary health care. Psychosomatic Medicine 67, 9971005.
Frostholm L, Fink P, Oernboel E, Christensen KS, Toft T, Olesen F, Weinman J (2005 b). The uncertain consultation and patient satisfaction: the impact of patients’ illness perceptions and a randomized controlled trial on the training of physicians’ communication skills. Psychosomatic Medicine 67, 897905.
Hansen MS, Fink P, Frydenberg M, Oxhoj ML (2002). Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosomatic Medicine 64, 668675.
Hansen HS, Rosendal M, Oernboel E, Fink P (2011). Are medically unexplained symptoms and functional disorders predictive for the illness course? A two-year follow-up on patients’ health and health care utilisation. Journal of Psychosomatic Research 71, 3844.
Hiller W, Fichter MM (2004). High utilizers of medical care: a crucial subgroup among somatizing patients. Journal of Psychosomatic Research 56, 437443.
Kettell J, Jones R, Lydeard S (1992). Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. British Journal of General Practice 42, 459461.
Leventhal H, Brissette I, Leventhal EA (2003). The common-sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaviour (ed. Cameron L. D. and Leventhal H.), pp. 4265. Routledge: London.
Martin A, Rauh E, Fichter M, Rief W (2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics 48, 294303.
Martin A, Rief W (2011). Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders. Psychiatric Clinics of North America 34, 565578.
Morriss R, Gask L, Ronalds C, Downes-Grainger E, Thompson H, Leese B, Goldberg D (1998). Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs. Family Practice 15, 119125.
Moss-Morris R, Chalder T (2003). Illness perceptions and levels of disability in patients with chronic fatigue syndrome and rheumatoid arthritis. Journal of Psychosomatic Research 55, 305308.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 116.
Petrie KJ, Weinman J (2012). Patients’ perceptions of their illness: the dynamo of volition in health care. Current Directions in Psychological Science 21, 6065.
Reid S, Wessely S, Crayford T, Hotopf M (2002). Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. British Journal of Psychiatry 180, 248253.
Rief W, Broadbent E (2007). Explaining medically unexplained symptoms – models and mechanisms. Clinical Psychology Review 27, 821841.
Rosendal M, Bro F, Fink P, Christensen KS, Olesen F (2003). Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial. British Journal of General Practice 53, 917922.
Schroder A, Fink P (2011). Functional somatic syndromes and somatoform disorders in special psychosomatic units: organizational aspects and evidence-based treatment. Psychiatric Clinics of North America 34, 673687.
Severeijns R, Vlaeyen JW, van den Hout MA, Picavet HS (2004). Pain catastrophizing is associated with health indices in musculoskeletal pain: a cross-sectional study in the Dutch community. Health Psychology 23, 4957.
Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F (2005). Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary Care (FIP) study. Psychological Medicine 35, 11751184.
Toft T, Rosendal M, Ornbol E, Olesen F, Frostholm L, Fink P (2010). Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study). Psychotherapy and Psychosomatics 79, 227237.
World Health Organization (1998). SCAN: Schedules for Clinical Assessment in Neuropsychiatry, version 2.1. WHO Division of Mental Health: Geneva.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 44 *
Loading metrics...

Abstract views

Total abstract views: 172 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.