A brief psychodynamic-interpersonal psychotherapy for patients with multisomatoform disorder (PISO) – one size fits all?

Aims: the revision of the DSM-V will probably bring forward a new category „Complex Somatic Symptom Disorder“, with the main criteria “one or more somatic symptoms that are distressing and/or result in significant disruption in daily life“. This leads to the question whether one therapeutic approach could effectively influence the whole variety of these symptoms in question.

Methods: we recently completed a multicentric RCT to investigate a brief psychodynamic-interpersonal psychotherapy for patients with multisomatoform disorder (PISO). 211 Patients were randomly assigned to receive 12 weekly sessions of PIT or 3 sessions of enhanced medical care.

Results: the effect size of the improvement in the pre-specified primary outcome (physical component summary of the SF–36) 9 months after end of treatment was 0.61 for PIT and 0.32 for EMC. This resulted in a small to medium but significant between group effect size d=0.37 (p=0.003). The patients reported on average 10.0 distressing / disruptive symptoms (as assessed by a modified version of the SCID) with a mean duration of 10.4 years. The symptoms represented the whole diversity of symptoms (pain, pseudo-neurologic, gastrointestinal, sexual functioning). Most frequent were unspecific symptoms as fatigue or dizziness. No single symptom was associated to therapeutic outcome, neither was the symptom sum.

Conclusion: PIT demonstrated its long term efficacy in improving bodily quality of life in patients with a variety of multiple, difficult to treat somatoform symptoms, regardless the individual symptom pattern.

Literature: Brief psychodynamic-interpersonal psychotherapy for patients with multisomatoform disorder: a randomized controlled trial Henningsen P, Sattel H, Gündel H, Guthrie E, Kruse J, Lahmann C, Noll-Hussong M, Ohmann C, Ronel J, Sack M, Sauer N, Schneider G. Brit J Psychiat, Submitted

Complex Somatic Symptom Disorder; Somatoform Disorder - Psychodynamic Interpersonal Psychotherapy - Randomized Clinical Trial