Table 2 Clinical characteristics of a more serious course (“yellow flags”) (based on 1, 2, 3, 4, 10, 11).

Several symptoms (poly-symptomatic course)

No or only rare/short periods without symptoms

Severe fear of disease

Highly dysfunctional utilization of healthcare services, defensive avoidance strategies

Incapacity to work > 4 weeks, social withdrawal

High levels of stress in current situation and in prior history

Severe psychological co-morbidities (depression, anxiety, PTSD, addiction, personality disorder)

Patient-physician relationship experienced as “difficult” (by both parties), frustrating, treatment frequently discontinued

Iatrogenic somatisation (e.g. focus on catastrophic outcomes, invasive procedures which are not indicated)