The outcome of medically unexplained symptoms—Will DSM-V improve on DSM-IV somatoform disorders?

Abstract

This systematic review aimed to identify (1) what is patients, so the course and outcome are bound to vary known about the course and outcome of medically unexplained symptoms and (2) the determinants of outcome. The authors approached this topic from the perspective of primary care contrasting the published literature, which tends to regard medically unexplained symptoms as a group of chronic and disabling disorders, with that from primary care where many patients have transient medically unexplained symptoms with a good prognosis. Their search of the literature concerned “medically unexplained symptoms,” “somatisation disorder,” and “hypochondriasis” but was not very fruitful: only six articles concerned with the outcome of medically unexplained symptoms, six articles on hypochondriasis, and one article on abridged somatization met their inclusion criteria. Nearly half of these studies had been included in a review published 4 years ago [1]. The inclusion criteria were not unreasonable; the relevant research has not been done. For example, the authors could not find any prospective cohort study on DSM-IV somatoform disorders. The authors decided not to study specific “functional” syndromes, such as chronic widespread pain, chronic fatigue syndrome, and irritable bowel syndrome, or single symptom disorders, such as headache, as they considered that the undifferentiated medically unexplained symptoms present the greatest difficulty to doctors. There are a number of difficulties with such work. The principal one lies in the fact that patients described as having medically unexplained symptoms do not have a discrete disorder—they form a heterogeneous group of