Joel Yager, MD

In a registry study, diagnoses of somatoform disorders were preceded by increased rates of infections, particularly severe ones.

The etiologies and pathogeneses of medically unexplained, functional somatic symptoms are obscure. These include somatoform and somatization disorders and, often, chronic fatigue, fibromyalgia, and irritable bowel syndromes. Previous studies examining the role of infections in somatoform disorders have yielded inconsistent findings. Dutch investigators retrospectively analyzed data from a general practitioners (GPs) network registry and a psychiatric registry on 185 patients seen in psychiatric clinics and diagnosed with undifferentiated somatoform disorder, somatization disorder, or pain disorder and on age-, sex-, and postal-code–matched controls without somatization or psychotic disorders.

The investigators analyzed GP visits for infections both for the total period with available data (mean, 10.5 years) and for the 3-year period immediately before the somatoform diagnosis. Factors examined were total and medication-treated infection load and severity of infection. For both the entire period and the 3-year prediagnosis period, somatoform disorder patients had more GP visits than controls and higher total infection loads. For the entire period, somatoform patients also had more medication-treated infections and higher numbers of severe, localized, acute infections (e.g., appendicitis). Patients who received somatoform diagnoses soon after seeing GPs had higher infection loads than those who had a gap between the GP visit and such diagnoses.

Citation(s):

Lacourt TE et al. Infection load as a predisposing factor for somatoform disorders: Evidence from a Dutch general practice registry. Psychosom Med 2013 Aug 19; [e-pub ahead of print].