Somatoform Disorders and Recent Diagnostic Controversies

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Several classification issues regarding somatoform disorders are being debated as the process for revising the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) unfolds over the next 5 years. Eight key questions center around the appropriate stakeholders for DSM-V, changes in terminology, movement of certain disorders within or outside of Axis I, the validity of symptom explanation as a core criterion, the status of functional somatic syndromes, the reliance on symptom counts, the reliability of lifetime symptom recall, and the value of symptom grouping. Somatic symptom measures are reviewed, and a brief self-rated scale is described in detail.

Section snippets

Defining Somatic Symptoms, Physical/Medical Comorbidity, and Somatization

Somatoform disorders cannot be discussed without briefly defining several key but sometimes misconstrued terms. Symptoms commonly are labeled “somatic” in psychiatry and other mental health disciplines, in part to distinguish bodily symptoms from cognitive, emotional, or other types of nonsomatic symptoms. In contrast, general medical, surgical, and other non–mental health disciplines more often refer to bodily symptoms as “physical” symptoms. The distinction is not solely semantic. Labeling a

Background

A vigorous debate has occurred over the past several years regarding the current classification of somatoform disorders, with opinions ranging from the radical abolishment of the entire category to more subtle refinements. The more extreme view is articulated by Mayou and colleagues in a position paper [24], whereas a more diverse range of positions is represented in a recent series of eight articles in a 2006 issue of the Journal of Psychosomatic Research [25], [26], [27], [28], [29], [30],

Measuring Somatic Symptoms

The assessment and outcome monitoring of many medical disorders rely on measurement (eg, blood pressure readings in hypertension, serum glucose in diabetes, peak flow in asthma, and noninvasive assessment of coronary perfusion in cardiovascular disease). Validated measures traditionally have been used in psychiatric research but not routinely in clinical practice. Several brief self-rated measures have been evaluated, however, for use in depression [80], and the recent Sequenced Treatment

Summary

Classification is not a trivial matter. In Burmese Days, George Orwell writes, “It is devilish to suffer from a pain that is all but nameless. Blessed are they who are stricken only with classifiable diseases! Blessed are the poor, the sick, the crossed in love, for at least other people know what is the matter with them and will listen to their belly-achings with sympathy.” Patients who have somatoform disorders are particularly susceptible to this Orwellian lamentation. They are afflicted by

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