Multidimensionale Beurteilung somatoformer Störungen im versicherungspsychiatrischen Kontext

There is much debate about disability due to somatoform disorders and possible guidelines for an adequate medical expert assessment in this re spect. The ambiguity of the diagnostic concept and its questionable vali dity are discussed. On the basis of more recent evidence, a multidimen sional approach is proposed in order to overcome these shortcomings in the evaluation of a possibly somatoform symptomatology. The following dimen sions should be part of such an approach: the characteristics of somatoform complaints, course on time axis, comorbidity, subjective illness appraisal and coping strategies. Somatoform disorders must be differentiated from sim ple dysfunctional beliefs and behaviour patterns. Moreover, disorderspe cific factors are outlined that can help to define the prognosis. In addition, to assess psychological resources within the frame of personality structure a diagnostic procedure according to the Operationalized Psychodynamic Diag nosis (OPD) system is recommended. Diagnostics according to OPD can help to answer the difficult question whether in a given situation somatoform disorder results in a transient or rather permanent and relevant restriction of functioning also from a medicolegal point of view.