DSM-5 Somatic Symptom Disorder Research Articles

Do indicators for DSM-5 sexual dysfunction and somatic symptom disorder overlap? Evidence from the Hamburg City Health Study population-based sample.

Symptoms of sexual dysfunction and somatic symptom disorder may resemble each other in their presentation as lasting and distressing alterations of expected bodily "functioning"; their co-occurrence has not yet been studied in nonclinical settings or by DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). To investigate (1) the association of indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses, (2) whether individuals with different sexual dysfunction diagnoses differ in somatic symptoms and their perception, and (3) whether distress from sexual difficulties is related to somatic symptoms and symptom perception. We examined links among sexual dysfunctions/distress from sexual difficulties (Brief Questionnaire on Sexuality), somatic symptom severity (Patient Health Questionnaire-15 [PHQ-15]), and symptom perception (Somatic Symptom Disorder-B Criteria Scale) in 9333 participants of the Hamburg City Health Study aged 45 to 74 years. For a sensitivity analysis, we repeated all analyses after excluding an item on sexual difficulties from the PHQ-15 score. Outcomes included scores on the Brief Questionnaire on Sexuality indicating sexual difficulties and dysfunction according to DSM-5, PHQ-15 for somatic symptom severity, and Somatic Symptom Disorder-B Criteria Scale for symptom perception. Indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses were linked (P = .24) before the sensitivity analysis but not after. Individuals with different sexual dysfunction diagnoses did not differ in their somatic symptom severity or their symptom perception. Distress from sexual difficulties was weakly correlated with somatic symptom severity (after sensitivity analysis: ρ = .19, P = .01) and symptom perception (ρ = .21, P = .01). Both correlations were stronger for men than for women. Our results convey that it is worth exploring sexual difficulties and somatic symptom disorder in patients presenting with either complaint but also that sexual difficulties should still be regarded as an independent phenomenon. Our sample consisted of participants from one metropolitan region who were >45years of age and thus does not demographically represent the general population. Assessing via self-report questionnaires may have influenced the reporting of symptoms, as may have prevailing shame around experiencing sexual dysfunction. The final sample size was reduced by missing values from some questionnaires. Despite these limitations, sample sizes for all analyses were large and offer meaningful new observations on the subject. Our data suggest that indicators for sexual dysfunction and somatic symptom disorder somewhat overlap but still represent distinct phenomena and should be treated accordingly in research and clinical practice.

Advancements in Understanding and Classifying Chronic Orofacial Pain: Key Insights from Biopsychosocial Models and International Classifications (ICHD-3, ICD-11, ICOP).

In exploring chronic orofacial pain (COFP), this review highlights its global impact on life quality and critiques current diagnostic systems, including the ICD-11, ICOP, and ICHD-3, for their limitations in addressing COFP's complexity. Firstly, this study outlines the global burden of chronic pain and the importance of distinguishing between different pain types for effective treatment. It then delves into the specific challenges of diagnosing COFP, emphasizing the need for a more nuanced approach that incorporates the biopsychosocial model. This review critically examines existing classification systems, highlighting their limitations in fully capturing COFP's multifaceted nature. It advocates for the integration of these systems with the DSM-5's Somatic Symptom Disorder code, proposing a unified, multidisciplinary diagnostic approach. This recommendation aims to improve chronic pain coding standardization and acknowledge the complex interplay of biological, psychological, and social factors in COFP. In conclusion, here, we highlight the need for a comprehensive, universally applicable classification system for COFP. Such a system would enable accurate diagnosis, streamline treatment strategies, and enhance communication among healthcare professionals. This advancement holds potential for significant contributions to research and patient care in this challenging field, offering a broader perspective for scientists across disciplines.

Somatic Symptom Disorder-B criteria scale (SSD-12): Psychometric properties of the French version and associations with health outcomes in a population-based cross-sectional study

ObjectiveThe 12-item Somatic Symptom Disorder-B Criteria Scale (SSD-12) is a self-reported questionnaire designed to assess the B criteria of the DSM-5 somatic symptom disorder. In this cross-sectional study, we aimed to examine the psychometric properties of the SSD-12 French version and associated health outcomes. MethodsParticipants were volunteers from the population-based CONSTANCES cohort who reported at least one new symptom that occurred between March 2020 and January 2021. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression scale (CES-D). ResultsA total of 18,796 participants completed the SSD-12. The scree plot was consistent with a 1-factor structure, while goodness-of-fit indices of the confirmatory factorial analyses and clinical interpretability were consistent with a 3-factor structure (excluding the item 7): ‘Perceived severity’, ‘Perceived impairment’, ‘Negative expectations’. The Cronbach's α coefficients of the total and factors scores were 0.90, 0.88, 0.84 and 0.877, respectively.The total score was associated with depressive symptoms (Spearmann's rho: 0.32), self-rated health (−0.46), the number of persistent symptoms (0.32), and seeking medical consultation (odds ratio [95% confidence interval] for one interquartile range increase: 1.51 [1.48–1.54]). Among participants seeking medical consultation, those with higher SSD-12 scores were more likely to have their symptoms attributed to “stress/anxiety/depression” (1.32 [1.22–1.43]) and “psychosomatic origin” (1.25 [1.20–1.29]), and less to “COVID-19” (0.89 [0.85–0.93]). ConclusionWhile the SSD-12 French version can be used as a unidimensional tool, it also has a 3-factor structure, somewhat different from the DSM-5 theoretical structure, with high internal consistency and clinically meaningful associations with other health outcomes.

What does the clinician have to gain from distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety?

What does the clinician have to gain from distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety?

Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter?

ObjectiveTo investigate the validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder (SSD) and illness anxiety disorder (IAD) in pathological health anxiety: the excessive and recurrent fear of, or preoccupation with, having or developing a serious health condition. MethodsWe compared SSD to IAD in pathological health anxiety (N = 334) with regard to concurrent, antecedent, and predictive validators. This was primarily a cross-sectional study, though we studied the effect of CBT longitudinally. Because we were interested in the discriminatory value of SSD and IAD over and above trait health anxiety, we used trait health anxiety as a covariate. ResultsSSD (68%; 228/334) vs. IAD (32%; 106/334) differences were mostly non-significant and small in sociodemographics, core clinical characteristics, apparent course, etiological attribution, and physician visits (gs = −0.18–0.20; RRs = 0.84–1.09; IRRs = 0.87–0.99). However, SSD was associated with a significantly higher somatic symptom burden (gs = 0.20–0.72), more psychologist visits (IRR = 2.02, 95% CI: 1.24–3.28), and slightly higher disability (g = 0.22, 95% CI: 0.03–0.42). There was no significant difference in symptom reduction during CBT (g = −0.16, 95% CI: −0.37-0.05). ConclusionAlthough not all differences between SSD and IAD in pathological health anxiety seem to be explained by the level of trait health anxiety, the SSD vs. IAD distinction appears to convey little useful information in pathological health anxiety. Tentatively, considering the well-documented clinical characteristics and effective clinical interventions, it is probably most helpful to regard pathological health anxiety as a de facto anxiety or perhaps obsessive-compulsive spectrum disorder, regardless of the DSM-5 diagnosis of SSD or IAD.

Detecting DSM-5 somatic symptom disorder in general hospitals in China: B-criteria instrument has better accuracy-A secondary analysis.

This study investigates the diagnostic accuracy of the PHQ-15, SSS-8, SSD-12 and Whitley 8 and their combination in detecting DSM-5 somatic symptom disorder in general hospitals. In our former multicenter cross-sectional study enrolling 699 outpatients from different departments in five cities in China, SCID-5 for SSD was administered to diagnose SSD and instruments including PHQ-15, SSS-8, SSD-12 and WI-8 were used to evaluate the SSD A and B criteria. In this secondary analysis study, we investigate which instrument or combination of instrument has best accuracy for detecting SSD in outpatients. Receiver operator curves were created, and area under the curve (AUC) analyses were assessed. The sensitivity and specificity were calculated for the optimal individual cut points. Data from n = 694 patients [38.6% male, mean age: 42.89 years (SD = 14.24)] were analyzed. A total of 33.9% of patients fulfilled the SSD criteria. Diagnostic accuracy was moderate or good for each questionnaire (PHQ-15: AUC = 0.72; 95% CI = 0.68-0.75; SSS-8: AUC = 0.73; 95% CI = 0.69-0.76; SSD-12: AUC = 0.84; 95% CI = 0.81-0.86; WI-8: AUC = 0.81; 95% CI = 0.78-0.84). SSD-12 and WI-8 were significantly better at predicting SSD diagnoses. Combining PHQ-15 or SSS-8 with SSD-12 or WI-8 showed similar diagnostic accuracy to SSD-12 or WI-8 alone (PHQ-15 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; PHQ-15 + WI-8: AUC = 0.82; 95% CI = 0.79-0.85; SSS-8 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; SSS-8 + WI-8: AUC = 0.82; 95% CI = 0.79-0.84). In the efficiency analysis, both SSD-12 and WI-8 showed good efficiency, SSD-12 slightly more efficient than WI-8; however, within the range of good sensitivity, the PHQ-15 and SSS-8 delivered rather poor specificity. For a priority of sensitivity over specificity, the cutoff points of ≥13 for SSD-12 (sensitivity and specificity = 80 and 72%) and ≥17 for WI-8 (sensitivity and specificity = 80 and 67%) are recommended. In general hospital settings, SSD-12 or WI-8 alone may be sufficient for detecting somatic symptom disorder, as effective as when combined with the PHQ-15 or SSS-8 for evaluating physical burden.

Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study

Exposure to illness-related stimuli is a crucial component of CBT for pathological health anxiety. Modern exposure approaches focus on forming inhibitory associations and provide promising results. An implementation in the treatment of pathological health anxiety is still missing. The present single case series study investigated the applicability and effects of an inhibitory learning-based exposure approach (12 sessions) on health anxiety, safety behavior, and tolerance for aversive states in n = 7 outpatients (age: M = 35.14, SD = 8.43) with a DSM-5 Illness Anxiety Disorder or Somatic Symptom Disorder with predominant health worries in multilevel models. A high intervention satisfaction and little adverse effects were reported. A significant(ly) (steepened) reduction of health anxiety (b = −0.10, pbaseline < .001, ppre-intervention = .003), and body checking behavior (b = −0.14, pbaseline/pre-intervention < .001), and a significant increase in distress tolerance (b = 0.07, pbaseline = .02, ppre-intervention = .004), discomfort tolerance (b = 0.11, pbaseline/pre-intervention < .001), and insecurity tolerance (b = 0.13, pbaseline/pre-intervention < .001) were observed during the intervention in comparison to the baseline and pre-intervention phase. The present study provided first evidence that the principles of inhibitory learning can be effectively applied to the exposure-based treatment of pathological health anxiety.

A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial

BackgroundExposure-based psychological treatment appears to have beneficial effects for several patient groups that commonly report distress related to persistent somatic symptoms. Yet exposure-based treatment is rarely offered in routine care. This may be because existing treatment protocols have been developed for specific symptom clusters or specific unwanted responses to somatic symptoms, and many clinics do not have the resources to offer all these specialised treatments in parallel. In preparation for a randomised controlled trial, we investigated the feasibility of a new and unified Internet-delivered exposure treatment (OSF.io: cnbwj) for somatic symptom disorder regardless of somatic symptom domain (e.g. cardiopulmonary, fatigue, gastrointestinal, pain), combination of unwanted emotions (e.g. anger, anxiety, fear, shame) and whether somatic symptoms are medically explained or not. We hypothesised that a wide spectrum of subgroups would show interest, that the treatment would be rated as credible, that adherence would be adequate, that the measurement strategy would be acceptable and that there would be no serious adverse events.MethodsSingle-group prospective cohort study where 33 self-referred adults with undifferentiated DSM-5 somatic symptom disorder took part in 8 weeks of unified Internet-delivered exposure treatment delivered via a web platform hosted by a medical university. Self-report questionnaires were administered online before treatment, each week during treatment, post treatment and 3 months after treatment.ResultsParticipants reported a broad spectrum of symptoms. The Credibility/Expectancy mean score was 34.5 (SD = 7.0, range: 18–47). Participants completed 91% (150/165) of all modules and 97% of the participants (32/33) completed at least two exposure exercises. The average participant rated the adequacy of the rationale as 8.4 (SD = 1.5) on a scale from 0 to 10. The post-treatment assessment was completed by 97% (32/33), and 84% (27/32) rated the measurement strategy as acceptable. The Client Satisfaction Questionnaire mean score was 25.3 (SD = 4.7, range: 17–32) and no serious adverse events were reported. Reductions in subjective somatic symptom burden (the Patient Health Questionnaire 15; d = 0.90) and symptom preoccupation (the somatic symptom disorder 12; d = 1.17) were large and sustained.ConclusionsDelivering a unified Internet-delivered exposure-based treatment protocol for individuals with undifferentiated somatic symptom disorder appears to be feasible.Trial registrationClinicalTrials.gov, NCT04511286. Registered on August 13, 2020.

Relations between criteria for somatic symptom disorder and quality of life in asylum seekers living in Germany

ObjectiveAsylum seekers often suffer from medically unexplained symptoms that affect their quality of life (QoL). The present study is the first to investigate the extent to which somatic symptoms and the B criteria for the DSM-5 somatic symptom disorder (SSD) are associated with the QoL of asylum seekers living in Germany. MethodsIn 144 asylum seekers, somatic symptoms (PHQ-15), B criteria for SSD, symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), post-migration living difficulties (PMLD), and QoL (EUROHIS) were assessed cross-sectionally. Multiple regressions in the total sample and in groups of somatic symptom severity (mild/moderate and severe) were conducted to examine the associations between somatic symptoms and B criteria with QoL. ResultsSleep problems and pain were the most frequently reported somatic symptoms. Sixteen (11%) participants met one B criterion, 24 (17%) met two, and 84 (58%) met all three criteria. QoL correlated negatively with somatic symptoms (r = −0.56, p < .001) and with the existence of at least one B criterion (r = −0.24, p < .001). In the total sample, stronger depressive and somatic symptoms were related to lower QoL (adjusted R2 = 0.53) while the B criteria were not. In persons with severe somatic symptom severity, the B criterion behavior was associated with lower QoL. ConclusionIn addition to stronger somatic and depressive symptoms, the psychological B criterion behavior seems to play an important role in the lower QoL of asylum seekers with severe somatic symptoms.

Prevalence of DSM-5 somatic symptom disorder in Chinese patients with breast cancer.

The aims of this study were to explore the frequency of somatic symptom disorder (SSD) and the relationship between SSD and somatic, psychological, and social factors in Chinese patients with breast cancer. This multicenter cross-sectional study enrolled 264 patients with breast cancer from three different departments in Beijing. The structured clinical interview for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (SCID-5) for SSD. Standardized questionnaires and clinical data were used to compare patients with and without SSD. Somatic symptom disorder was diagnosed in 21.6% (57/264) of all enrolled patients. No differences were found between SSD patients and non-SSD patients in terms of sociodemographic characteristics and tumor-specific variables, except radiotherapy. However, patients with SSD reported higher levels of depression, anxiety and cancer-related worry. They also showed a longer duration of symptoms, greater impairment in daily life, more concern over their physical complaints and more doctor visits. In a stepwise binary logistic regression analysis, among others, higher health anxiety (WI-8, Exp(B)=0.107, p=0.009) and more doctor visits (OR=-1.841, p<0.001) showed a significant association with SSD; the model explained 53.7% of the variance. Similar to other physical diseases, there is a high prevalence of SSD in patients with breast cancer. Somatic symptom disorder patients differ from non-SSD patients by exhibiting higher cancer-related emotional distress and dysfunctional illness perception and behavior. There remain substantial challenges in the diagnosis of SSD in patients with cancer and other medical conditions. ChiCTR2100051525.

Persistence rate of DSM-5 somatic symptom disorder: 4-year follow-up in patients from a psychosomatic outpatient clinic

BackgroundSomatic Symptom and Related Disorders (SSD) were introduced by DSM-5 in order to improve the classification of somatoform disorders. There is a lack of longitudinal studies on course and predictors of SSD. The present study investigates the natural course of SSD in a four-year follow-up study in patients from a psychosomatic outpatient clinic. Material and methodsAt baseline, n = 360 outpatients completed a semi-structured clinical interview to assess SSD, and additional self-report questionnaires (SSS-8, SSD-12, PHQ-8, GAD-7, SF-12). 112 patients were re-assessed after four years. Persistence rate and predictors for persisting SSD were evaluated. ResultsThe prevalence rate of SSD at baseline was 51.8%, and 47.3% at follow-up. We found a persisting SSD in 30.4% (n = 34) of the patients, a remission rate of 21.4% (n = 24) and an incidence rate of 16.9% (n = 19). 31.3% (n = 35) of the sample never received a SSD diagnosis. Significant predictors for persistence were a high psychological burden through somatic symptoms (OR: 1.13, 95% CI: 1.01–1.26) and general anxiety (OR: 1.38, 95% CI: 1.01–1.88) at baseline. ConclusionThis study indicates that SSD is highly prevalent and persistent in patients from a psychosomatic setting. Our findings indicate that psychological and behavioral factors contribute to the maintenance of SSD and present potential targets for interventions. Future interventions for SSD could potentially be optimized by addressing psychological processes such as catastrophic thinking styles and symptom focusing.

Application and validation of the bodily distress syndrome checklist in a psychosomatic outpatient sample

ObjectiveThe BDS checklist is a self-report measure to assess the most common somatic symptoms in functional somatic syndromes, based on the diagnostic concept of Bodily Distress Syndrome. The aim of the study was to examine the psychometric properties and validity of the BDS checklist in a psychosomatic sample and to investigate whether it is suitable to detect DSM-5 somatic symptom disorders (SSD). MethodIn a cross-sectional study, n = 368 patients from a psychosomatic outpatient clinic completed the BDS checklist and a semi-structured clinical interview on SSD. Item and scale characteristics and measures of reliability and validity were determined. ResultsThe BDS checklist showed good item characteristics and reliability (Cronbach α = 0.89). Factor analysis confirmed four symptom clusters (CFI = 0.95, TLI = 0.95, RMSEA = 0.091, 90% CI = 0.085–0.097). The BDS total score showed significant correlations with other measures of somatic symptom burden (r = 0.79, p < .001), health anxiety (r = 0.46, p < .001), depression (r = 0.45, p < .001), and general anxiety (r = 0.41, p < .001). Higher BDS checklist scores were associated with higher physical and mental health impairment and higher health care use. Diagnostic accuracy regarding somatic symptom disorder was moderate (AUC = 0.72, 95% CI: 0.67–0.77). ConclusionFindings of our study indicate that the BDS checklist is a reliable and valid measure to assess the most common somatic symptoms in a psychosomatic setting. It is however not sufficient to detect persons at risk for somatic symptom disorder. A combination with further questionnaires could probably improve diagnostic accuracy.

IL-6 and hsCRP in Somatic Symptom Disorders and related disorders

BackgroundInterleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are biomarkers of systemic low-grade inflammation (SLI) in depression and anxiety. The question if SLI in those conditions is related to comorbid chronic medical conditions has not been resolved. DSM-5 Somatic symptom disorders and related disorders (SSRD) are conditions with serious distress related to physical symptoms as main criterion. They can occur in patients with medically unexplained symptoms (MUS) and in patients with known comorbid chronic medical conditions. Often, comorbid depression and anxiety are present. SSRDs offer the opportunity to explore the role of SLI in relation to mental distress, including trauma, MUS, chronic medical conditions and comorbid mental disorder. AIM: We hypothesized that increased IL-6 and hsCRP may be directly linked to SLI in SSRD, and that comorbid chronic medical conditions, childhood trauma, current stress and comorbid depression and anxiety may be risk factors that account for some of the variance of SLI in SSRD. METHODS: We explored these relationships in a large sample of 241 consecutive outpatients with SSRD. RESULTS: Mean hsCRP level was 3.66 ​mg/l, and mean IL-6 level was 3.58 ​pg/ml. IL-6 and hsCRP levels were associated with each other: τ ​= ​0.249, p ​< ​.001; a medium size correlation. Comorbid chronic medical conditions, adverse childhood events other than sexual trauma, and current stress levels were not associated with IL-6 or hsCRP levels. CONCLUSION: IL-6 and hsCRP are elevated in SSRD, indicating SLI in SSRD independently of comorbid chronic medical conditions. In clinical research, elevated IL-6 and hsCRP can be used as biomarkers of SLI and can indicate risk for childhood sexual abuse in SSRD. Elevated hsCRP may be a biomarker indicating risk for comorbid depression or high pain levels in SSRD as well.

Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates.

BackgroundPatients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses.MethodsWe used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained.ResultsThere were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes ‘excessive.’ The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features.ConclusionsThe concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.

311 - Ten years of DSM-5 Somatic Symptom Disorders: A scoping review on empirical evidence

311 - Ten years of DSM-5 Somatic Symptom Disorders: A scoping review on empirical evidence

Validation of the Chinese Version of the Somatic Symptom Disorder-B Criteria Scale for Detecting DSM-5 Somatic Symptom Disorders: A Multicenter Study.

This study aimed to validate the Chinese version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in an outpatient sample from Chinese general hospitals and to determine the diagnostic performance of the SSD-12 as a screening tool for somatic symptom disorder (SSD). The Chinese version of the SSD-12 was completed by 699 outpatients from nine general hospitals during a 16-month period (2016-2018). The SSD section of the Structured Clinical Interview for DSM Disorders, Fifth Edition, Research Version, was used to determine diagnostic accuracy (criterion validity). The construct validity of the SSD-12 was evaluated by examining correlations with the Whiteley Index-7, Patient Health Questionnaire-15, Patient Health Questionnaire-9, General Anxiety Disorder-7, World Health Organization Disability Assessment Schedule, and Medical Outcome Study 12-item Short Form Health Survey (SF-12). The SSD-12 had excellent internal consistency in this sample (Cronbach α = .95). Confirmatory factor analyses replicated a three-factor structure that reflects the cognitive, affective, and behavioral aspects (Comparative Fit Index = 0.963, Tucker-Lewis Index = 0.952, root mean square error of approximation = 0.08, 90% confidence interval = 0.08-0.09), but was also consistent with a general one-factor model of the SSD-12 (Comparative Fit Index = 0.957, Tucker-Lewis Index = 0.948, root mean square error of approximation = 0.09, 90% confidence interval = 0.08-0.10). The optimal cutoff point for the Structured Clinical Interview for DSM Disorders-based diagnosis of SSD was 16 (sensitivity = 0.76, specificity = 0.80). The SSD-12 sum score was significantly associated with somatic symptom burden (Patient Health Questionnaire-15: r = 0.52, p < .001), health anxiety (Whiteley Index-7: r = 0.82, p < .001), depressive symptoms (Patient Health Questionnaire-9: r = 0.63, p < .001), general anxiety (General Anxiety Disorder-7: r = 0.64, p < .001), health-related quality of life (physical component score of SF-12: r = -0.49, p < .001; mental component score of SF-12: r = -0.61, p < .001), and health-related disabilities (World Health Organization Disability Assessment Schedule: r = 0.56, p < .001). Initial assessment indicates that the Chinese version of the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.

Distinct associations of DSM-5 Somatic Symptom Disorder, the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) and symptom severity in patients with irritable bowel syndrome

ObjectiveThe clinical management of high symptom severity is a challenging task with patients with functional somatic disorders. We investigated the extent to which DCPR-revised (DCPR-R) syndromes and the DSM-5 category of Somatic Symptom Disorder (SSD) were able to predict symptom severity in 203 consecutive tertiary care patients with irritable bowel syndrome (IBS). MethodSemistructured interview were used for assessing DCPR-R and validated scales for SSD (combining PHQ-12 and WI-7), severity of symptoms (IBS-SSS), psychological distress (HADS), and psychosocial functioning (SF-12). ResultsCompared to moderate severity (IBS-SSS = 175–300), patients in the high range of severity (IBS-SSS > 300) had significantly more DCPR-R syndromes (particularly alexithymia and persistent somatization), higher psychological distress, and poorer psychosocial functioning, but showed no difference for SSD.DCPR-R, particularly alexithymia and persistent somatization, significantly and independently predicted IBS severity by explaining 18.5% of the IBS-SSS variance with large effect size (d = 1.18), after controlling for covariables. Conversely, SSD was not able to significantly predict IBS severity. ConclusionsThis study highlights the need of an integrative approach in the medical setting. Psychosomatic factors play a relevant role in the individual perception of symptom severity and should be carefully evaluated for clinical management of functional syndromes.

Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care

ObjectiveWe aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. MethodsThis multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. ResultsSSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. ConclusionThere is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.

Prevalence of DSM-5 Somatic Symptom Disorder in Chinese Outpatients from General Hospital Care

Objective: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. Methods: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. Results: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (X2 = 34.049, df=2, p=<0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = .45. Conclusion: Patients with SSD have a high prevalence in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no competing interests to report. Ethical Approval Statement: The study was approved by the ethics committees of Peking Union Medical College Hospital (PUMCH) and the University Medical Centre Freiburg, Germany.

General practitioners' views on the diagnostic innovations in DSM-5 somatic symptom disorder - A focus group study

BackgroundThe innovations concerning the new diagnosis somatic symptom disorder (SSD) in the DSM-5 include the introduction of psychological diagnostic criteria and the elimination of the need to exclude all potential somatic causes of the symptoms. Thus far, it is unknown how general practitioners (GPs) evaluate the innovations conceptually and regarding their applicability in primary care. MethodWe performed six focus groups with GPs. A semi-structured interview-guideline included a presentation of the innovations of SSD and questions about the innovations and their potential (dis-)advantages from the GPs' points of view. The material was analyzed using structuring qualitative content analysis. ResultsA total of 41 GPs participated (mean (sd) age = 51 (8.5) years, female = 17, male = 24). The GPs assessed that the diagnostic innovations could help them to focus on symptom-related concerns and anxiety as core aspects of the patients' complaints. However, the meaning of the term excessive in the psychological diagnostic criteria (i.e., excessive worries, anxiety, time and energy) was ambiguous for the GPs. The GPs appreciated that a mental disorder can be assigned in addition to a severe physical disease. The GPs found it unlikely that diagnostic workup of somatic symptoms would be cut short if the diagnostic criteria of SSD were fulfilled in a given patient. ConclusionAltogether, for the GPs, the advantages of the new diagnostic criteria for SSD outweighed the disadvantages. In particular, the newly included psychological criteria were seen as an important advancement in comparison to the previous need of merely excluding a physical disease.