Ethical issues in the management of somatoform disorders

The somatoform disorders are a diverse group of conditions that are extremely common in primary and secondary care, but are only rarely seen by psychiatrists. Two important reasons for this are patient opposition to psychiatric diagnosis and the lack of convincing psychiatric models and treatments. Doctors managing these disorders will often find themselves in ethical conflict over the wish to provide treatment while respecting the patient’s autonomy. This is highlighted at the time of diagnosis, where doctors may be tempted to collude in giving a model they do not believe in order to create a therapeutic alliance. Though a path between these may be successfully negotiated, there are risks of harm to the patient, both through unnecessary investigations and by reinforcing the patient’s somatizing.