The Relationship Between Somatic Symptoms, Health Anxiety, and Outcome in Medical Out-Patients

Abstract

Somatic symptom disorders, also known as “somatoform” disorders, are common, distressing to patients, families, and physicians but surprisingly understudied. The definitions of these disorders include impairment and/or treatment seeking, but the relationship between the symptoms and cognitive characteristics of these disorders and later outcome has not been assessed adequately in prospective studies. In particular, it is not clear whether somatic symptoms, the hallmark of somatization, and health anxiety (hypochondriasis) have similar relationships with health status, medical treatment seeking, and satisfaction with care. These relationships are important in clinical practice in order to decide which disorders will resolve spontaneously and which will require psychological treatment. They are relevant also to the examination of the somatoform disorders in preparation for DSM-V. One of the aims of the current revision of the DSM is to incorporate a dimensional approach to diagnosis in addition to the categorical one. This is useful for research and many of the findings in the field of psychosomatics indicate that the relevant variables, such as number of somatic symptoms, physiological measures, and outcomes are distributed as continuous variables. The clinical utility of the dimensional approach is a little less clear, however, as cut points on relevant scales have not been reliably established. It is well recognized that blood pressure is distributed in the population as a continuous variable but there have also been established cut point values, above which complications are more likely. Similar cut points have not been established adequately in the field of somatic symptoms and health anxiety, although these are