Approach to the patient with multiple somatic symptoms

Med Clin North Am. 2014 Sep;98(5):1079-95. doi: 10.1016/j.mcna.2014.06.007. Epub 2014 Jul 9.


Primary care providers play a crucial role in the recognition and appropriate treatment of patients with multiple somatic complaints. Both the number of somatic symptoms and the persistence of symptoms are associated with co-occurring depression or anxiety disorders. It can be challenging to simultaneously address possible medical causes for physical symptoms while also considering an associated psychiatric diagnosis. In this article, strategies to improve the care and outcomes among these patients are described, including collaboration, education about the interaction between psychosocial stressors and somatic symptoms, regularly scheduled visits, focus on improving functional status, and evidence-based treatment of depression and anxiety.

Keywords: Anxiety; Collaborative care; Depression; Somatic symptoms; Somatization.

Publication types

  • Review

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy
  • Causality
  • Cognitive Behavioral Therapy
  • Depression / diagnosis
  • Depression / therapy
  • Diagnostic and Statistical Manual of Mental Disorders
  • Humans
  • Medical History Taking
  • Patient Care Team
  • Physical Examination
  • Physician-Patient Relations
  • Primary Health Care*
  • Referral and Consultation
  • Risk Factors
  • Severity of Illness Index
  • Somatoform Disorders / diagnosis*
  • Somatoform Disorders / psychology
  • Somatoform Disorders / therapy*
  • Stress, Psychological / psychology
  • Surveys and Questionnaires


  • Antidepressive Agents