Supplementary Material for: Management of Functional Somatic Syndromes and Bodily Distress

Functional somatic syndromes (FSS), like irritable bowel syndrome or
fibromyalgia and other symptoms reflecting bodily distress, are common
in practically all areas of medicine worldwide. Diagnostic and
therapeutic approaches to these symptoms and syndromes vary
substantially across and within medical specialties from biomedicine to
psychiatry. Patients may become frustrated with the lack of effective
treatment, doctors may experience these disorders as difficult to treat,
and this type of health problem forms an important component of the
global burden of disease. This review intends to develop a unifying
perspective on the understanding and management of FSS and bodily
distress. Firstly, we present the clinical problem and review current
concepts for classification. Secondly, we propose an integrated
etiological model which encompasses a wide range of biopsychosocial
vulnerability and triggering factors and considers consecutive
aggravating and maintaining factors. Thirdly, we systematically
scrutinize the current evidence base in terms of an umbrella review of
systematic reviews from 2007 to 2017 and give recommendations for
treatment for all levels of care, concentrating on developments over the
last 10 years. We conclude that activating, patient-involving, and
centrally acting therapies appear to be more effective than passive ones
that primarily act on peripheral physiology, and we recommend stepped
care approaches that translate a truly biopsychosocial approach into
actual management of the patient.