Skip to main content

Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists

  • Christopher Bass (a1), Robert Peveler (a1) and Allan House (a1)

Somatoform disorders have few peers in terms of personal morbidity and cost to the health service, yet many psychiatrists train without any experience of them.


To review the prevalence, disability and economic burden of somatoform disorders, and to explore the reasons why they are neglected by psychiatrists.


A selective review of the key literature.


Psychiatrists' current preoccupation with so-called ‘serious mental illness’ gives somatoform disorders low priority. Some health planners have erroneously equated severity with diagnosis rather than level of need and disability. As a consequence the development of psychiatric services has been neglected.


Greater recognition of the importance of somatoform disorders will only occur if high quality research and teaching receive priority, and if the Royal Colleges continue to press for increasing public awareness of their importance. Services should be driven by clinical need rather than diagnosis.

Corresponding author
C. Bass, Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU. Tel: 01865220379; Fax: 01865 220373
Hide All

Declaration of interest


Hide All
Akagi, H. & House, A. (2001) Epidemiology of Conversion Hysteria. In Contemporary Approaches to the Study of Hysteria (eds Halligan, P., Bass, C. & Marshall, J.), pp. 7386. Oxford: Oxford University Press.
Anonymous (1976) The search for a psychiatric esperanto. British Medical Journal, ii, 600601.
Audit Commission (1996) Finding a Place. A Review of Mental Health Services for Adults. London: Stationery Office.
Australian Health Ministers (1998) Second National Mental Health Plan. Canberra: Mental Health Branch, Commonwealth Department of Health and Family Services.
Bass, C. & Murphy, M. (1991) Somatisation disorder in a British teaching hospital. British Journal of Clinical Practice, 45, 237244.
Benjamin, S., Barnes, D., Berger, S., et al (1988) The relationship of chronic pain, mental illness and organic disorders. Pain, 32, 121131.
Bhui, K. & Hotopf, M. (1997) Somatization disorder. British Journal of Hospital Medicine, 58, 145149.
Buchwald, D., Pearlman, T., Umali, J., et al (1996) Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy controls. American Journal of Medicine, 171, 364370.
Crimlisk, H., Bhatia, K., Cope, H., et al (1998) Slater revisited: 6-year follow-up study of patients with medically unexplained motor symptoms. British Medical Journal, 316, 582586.
Crisp, A. (1999) The stigmatization of sufferers with mental disorders. British Journal of General Practice, 49, 34.
Davison, P., Sharpe, M., Wade, D., et al (1999) Wheelchair patients with non-organic disease: a psychological enquiry. Journal of Psychosomatic Research, 47, 93103.
Department of Health (1999) A National Service Framework for Mental Health. London: Department of Health.
Dolin, S. & Stephens, J. (1998) Pain clinics and liaison psychiatry. Anaesthesia, 53, 317319.
Feldman, E. (2000) Delivering services for severe somatoform disorders. In Severe Mental Illness (ed. Gregoire, A.), pp. 282293. Oxford: Greenwich Press.
General Medical Council (1993) Tomorrow's Doctors. Recommendations on Undergraduate Training. London: GMC.
Gill, D. & Sharpe, M. (1999) Frequent consulters in general practice: a systematic review of studies of relevance, associations and outcome. Journal of Psychosomatic Research, 47, 115130.
Gureje, O., Von Korff, M., Simon, G., et al (1998) Persistent pain and well-being: a World Health Organization study in primary care. Journal of the American Medical Association, 280, 147151.
Guthrie, E., Creed, F. & Tomenson, B. (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100, 450457.
Guthrie, E., Moorey, J., Margison, F., et al (1999) Cost effectiveness of brief psychodynamic-interpersonal therapy in high utilisers of medical care. Archives of General Psychiatry, 56, 519526.
Hamilton, J., Campos, R. & Creed, F. (1996) Anxiety, depression and management of medically unexplained symptoms in medical clinics. Journal of the Royal College of Physicians, 30, 1820.
Hiller, W., Rief, W. & Fichter, M. (1997) How disabled are patients with somatoform disorders? General Hospital Psychiatry, 19, 432438.
Jenkins, R., Lewis, G., Bebbington, P., et al (1997) The National Psychiatric Morbidity Surveys of Great Britain – initial findings from the household survey. Psychological Medicine, 27, 775789.
Katon, W., Ries, R. & Kleinmann, A. (1984) A prospective study of 100 consecutive somatization patients. Comprehensive Psychiatry, 25, 305314.
Kerwick, S., Jones, R., Mann, A., et al (1997) Mental health care training priorities in general practice. British Journal of General Practice, 47, 225227.
Kroenke, K. & Swindle, R. (2000) Cognitive-behavioural therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics, 69, 205215.
Kroenke, K., Spitzer, R., de Gruy, F., et al (1997) Multisomatoform disorder. Archives of General Psychiatry, 54, 352358.
Lin, E. H., Katon, W., Von Korff, M., et al (1991) Frustrating patients: physician and patient perspectives among distressed high users of medical services. Journal of General Internal Medicine, 6, 241246.
Mayou, R., Bryant, B., Clark, D., et al (1994) Referrals to a cardiac clinic for chest pain and palpitations. British Heart Journal, 72, 548553.
Mayou, R., Bass, C. & Bryant, B. (1999) Management of non-cardiac chest pain: from research to clinical practice. Heart, 81, 387392.
Protheroe, D. & House, A. (1999) In-patient liaison psychiatry in the UK. A neglected option for improving the psychiatric care of medical patients. Psychiatric Bulletin, 23, 525527.
Royal College of Physicians & Royal College of Psychiatrists (1995) The Psychological Care of Medical Patients. Council Report CR35. London: Royal College of Psychiatrists.
Royal College of Psychiatrists (1992) Mental Health of the Nation: The Contribution of Psychiatry. Council Report CR16. London: Royal College of Psychiatrists.
Royal College of Surgeons & Royal College of Psychiatrists (1997) Report of the Working Party on the Psychological Care of Surgical Patients. Council Report CR55. London: Royal College of Psychiatrists.
Sharpe, M., Mayou, R., Seagroatt, V., et al (1994) Why do doctors find some patients difficult to help? Quarterly Journal of Medicine, 87, 187193.
Sharpe, M., Guthrie, E., Peveler, R., et al (1996a) The psychological care of medical patients: a challenge for undergraduate medical education. Journal of the Royal College of Physicians, 30, 202204.
Sharpe, M., Hawton, K., Simkin, S., et al (1996b) Cognitive behavioural treatment for chronic fatigue syndrome. British Medical Journal, 312, 2226.
Slater, E. (1965) Diagnosis of “hysteria”. British Medical Journal, ii, 13951399.
Smith, G. R., Monson, R. A. & Ray, D. C. (1986) Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilisation. Archives of Internal Medicine, 146, 6972.
Swartz, M., Landerman, R., George, L., et al (1991) Somatization disorder. In Psychiatric Disorders in America (eds Robins, F. & Regier, R.), pp. 220255. Washington, DC: American Psychiatric Association.
Wessely, S. (1996) The rise of counselling and the return of alienism. British Medical Journal, 313, 158160.
Wessely, S., Chalder, T., Hirsch, S., et al (1997) The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. American Journal of Public Health, 87, 14491455.
Recommend this journal

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

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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: 0
Total number of PDF views: 11 *
Loading metrics...

Abstract views

Total abstract views: 28 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 19th March 2018. This data will be updated every 24 hours.

Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists

  • Christopher Bass (a1), Robert Peveler (a1) and Allan House (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *