DSM-IV Somatoform Research Articles

Operationalization of diagnostic criteria of DSM-5 somatic symptom disorders

BackgroundThe aim of this study was to test the operationalization of DSM-5 somatic symptom disorder (SSD) psychological criteria among Chinese general hospital outpatients.MethodsThis multicenter, cross-sectional study enrolled 491 patients from 10 general hospital outpatient departments. The structured clinical “interview about cognitive, affective, and behavioral features associated with somatic complaints” was used to operationalize the SSD criteria B. For comparison, DSM-IV somatoform disorders were assessed with the Mini International Neuropsychiatric Interview plus. Cohen’s к scores were given to illustrate the agreement of the diagnoses.ResultsA three-structure model of the interview, within which items were classified as respectively assessing the cognitive (B1), affective (B2), and behavioral (B3) features, was examined. According to percentages of screening-positive persons and the receiver operator characteristic (ROC) analysis, a cut-off point of 2 was recommended for each subscale of the interview. With the operationalization, the frequency of DSM-5 SSD was estimated as 36.5% in our sample, and that of DSM-IV somatoform disorders was 8.2%. The agreement between them was small (Cohen’s к = 0.152). Comparisons of sociodemographic features of SSD patients with different severity levels (mild, moderate, severe) showed that mild SSD patients were better-off in terms of financial and employment status, and that the severity subtypes were congruent with the level of depression, anxiety, quality of life impairment, and the frequency of doctor visits.ConclusionsThe operationalization of the diagnosis and severity specifications of SSD was valid, but the diagnostic agreement between DSM-5 SSD and DSM-IV somatoform disorders was small. The interpretation the SSD criteria should be made cautiously, so that the diagnosis would not became over-inclusive.

DSM-5 somatic symptom disorder in patients with vertigo and dizziness symptoms

ObjectiveDSM-5 somatic symptom disorder (SSD) could potentially be a highly relevant diagnosis for patients with vertigo and dizziness. The criteria of SSD, particularly the B-criterion with its three components (cognitive, affective, behavioral), have however not yet been investigated in this patient group. MethodsWe evaluated a large sample (n=399) of outpatients presenting in a neurological setting. Physical examinations and a psychometric assessment (SCID-I) were conducted; patients completed self-report questionnaires. The diagnosis of SSD was assigned retrospectively. The prevalence of SSD, its diagnostic criteria, and its overlap with former DSM-IV somatoform disorders were evaluated; comparisons were drawn between (1) patients fulfilling different components of the B-criterion and (2) patients with diagnoses after DSM-IV vs. DSM-5. ResultsSSD was almost twice as common as DSM-IV somatoform disorders. Patients with all three components of the B-criterion reported the highest impairment levels. Patients with both DSM-IV somatoform disorders and DSM-5 SSD were more impaired compared to groups with one of the diagnoses; patients with DSM-IV somatoform disorders only were more impaired than those with SSD only. ConclusionsOur findings demonstrate that SSD is highly prevalent in patients with vertigo and dizziness. The classification of severity based on the number of psychological symptoms appears valid and may assist in finding suitable treatment options according to clinical practice guidelines. Future studies should investigate the overlap of SSD and other psychiatric disorders, this may assist in better defining the diagnostic criteria of SSD.

The relation between the patient health questionnaire-15 and DSM somatic diagnoses.

BackgroundOur purpose was to examine the reliability and validity of the Chinese version of the Patient Health Questionnaire-15 (PHQ-15) in Taiwan, and to explore its relation to somatoform disorders (DSM-IV) and to somatic symptom and related disorders (DSM-5).MethodsWe recruited 471 individuals, 151 with somatoform disorders and 200 with somatic symptom and related disorders. Subjects completed the Chinese version of the PHQ-15, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and received a DSM-IV- and DSM-5-based diagnostic interview. We performed exploratory factor analysis and assessed test-retest reliability, internal consistency, and correlation with BDI-II/BAI to confirm reliability and validity, and carried out ROC curve analysis to determine suitability for evaluation or screening purposes. PHQ-15 scores were compared between patients with various DSM-IV psychiatric diagnoses (such as DSM-IV somatoform disorders, panic disorder, other anxiety/depressive disorders) or no DSM-IV diagnosis and patients with DSM-5 somatic symptom and related disorders or no DSM-5 diagnosis.ResultsThe Chinese version identified cardiopulmonary, pain-fatigue, and gastrointestinal as major factors and had good reliability (0.803–0.930), internal consistency (0.637–0.861), and correlation coefficients with BDI-II/BAI (0.407–0.619, 0.536–0.721, respectively). The PHQ-15 scores were similar in patients with somatoform disorders and patients with panic disorder; higher in patients with somatoform disorders and panic disorder than in patients with other anxiety/depressive disorders; and significantly higher in patients with somatic symptom and related disorders than in patients without this diagnosis. The AUC of the PHQ-15 was 0.678 (cutoff 6/7) for screening somatoform disorders (DSM-IV) and 0.725 (cutoff 4/5) for screening somatic symptom and related disorders (DSM-5).ConclusionsThe Chinese version of the PHQ-15 is suitable for evaluating somatic symptom and related disorders. The preponderance of somatic symptom disorder in our sample, lack of evaluation of functional disorders, and recruitment solely from psychiatric clinics are possible limitations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1068-2) contains supplementary material, which is available to authorized users.

Geriatric Psychiatry: What's in a Name, and Five Concerns about DSM-5.

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Validation of the 4DSQ somatization subscale in the occupational health care setting as a screener.

Somatoform disorders (physical symptoms without medical explanation that cause dysfunction) are prevalent in the occupational health (OH) care setting and are associated with functional impairment and absenteeism. Availability of psychometric instruments aimed at assessing somatoform disorders is limited. In the OH setting, so far only the Patient-Health-Questionnaire 15 has been validated as screener for somatoform disorder, and has been shown to have moderate validity. The Four-Dimensional Symptom Questionnaire (4DSQ) is frequently used in the OH setting but the Somatization subscale is not validated yet. The aim of this study is to validate the 4DSQ Somatization subscale as screener for DSM-IV somatoform disorder in the OH setting by using the MINI interview as gold standard. Employees absent from work due to physical symptoms, for a period longer than 6 weeks and shorter than 2 years, were asked to participate in this study. They filled out the 4DSQ and underwent a MINI interview by telephone for DSM-IV classification. Specificity and sensitivity scores were calculated for all possible cut-off scores and a receiver operator curve was computed for the Somatization subscale. 95 % confidence intervals (95 % CIs) were calculated for sensitivity and specificity. The Somatization subscale of the 4DSQ has an optimal cut point of 9, with specificity and sensitivity equal to 64.3 % [95 % CI (53.6; 73.7 %)] and 60.9 % [95 % CI (40.8; 77.8 %)], respectively. Receiver operator curves showed an area under the curve equal to 0.61 [SE = 0.07; 95 % CI (0.48; 0.75)] for the Somatization subscale of the 4DSQ. The 4DSQ Somatization subscale is a questionnaire of moderate sensitivity and specificity.

Somatoform disorders and rheumatic diseases: from DSM-IV to DSM-V.

Medically unexplained symptoms are considered 'somatoform disorders' in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The introduction of this nosographic category has been helpful in drawing attention to a previously neglected area, but has not been successful in promoting an understanding of the disorders' biological basis and treatment implications, probably because of a series of diagnostic shortcomings. The newly proposed DSM-V diagnostic criteria try to overcome the limitations of the DSM-IV definition, which was organised centrally around the concept of medically unexplained symptoms, by emphasising the extent to which a patient's thoughts, feelings and behaviours concerning their somatic symptoms are disproportionate or excessive. This change is supported by a growing body of evidence showing that psychological and behavioural features play a major role in causing patient disability and maintaining high level of health care use. Pain disorders is the sub-category of DSM-IV somatoform disorders that most closely resembles fibromyalgia. Regardless of the diagnostic changes recently brought about by DSM-V, neuroimaging studies have identified important components of the mental processes associated with a DSM- IV diagnosis of pain disorder.

What’s Next for Somatic Symptom Disorder?

What’s Next for Somatic Symptom Disorder?

Highlights of Changes from DSM-IV to DSM-5

In DSM-5, somatoform disorders are now referred to as somatic symptom and related disorders. In DSM-IV, there was significant overlap across the somatoform disorders and a lack of clarity about their boundaries. These disorders are primarily seen in medical settings, and nonpsychiatric physicians found the DSM-IV somatoform diagnoses problematic to use. The DSM-5 classification reduces the number of these disorders and subcategories to avoid problematic overlap. Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed.

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder: Prospective 1-year follow-up study

ObjectiveTo compare the predictive validity and clinical utility of DSM-IV somatoform disorders and DSM-5 Somatic Symptom Disorder (SSD) at 12-month follow-up. MethodsIn a sample of psychosomatic inpatients (n=322, mean age=45.6years (SD 10.0), 60.6% females) we prospectively investigated DSM-IV somatoform disorders and the DSM-5 diagnosis of SSD plus a variety of psychological characteristics, somatic symptom severity, and health-related quality of life at admission, discharge, and follow-up. ResultsDSM-IV diagnoses and DSM-5 SSD similarly predicted physical functioning at follow-up; SSD also predicted mental functioning at follow-up. Bodily weakness, intolerance of bodily complaints, health habits, and somatic attribution at admission were significant predictors of physical functioning at follow-up. The change in physical functioning during inpatient therapy was a significant predictor for the course of physical functioning until follow-up. ConclusionsPsychological symptoms appear to be predictively valid diagnostic criteria for the 12-month functional outcome in patients with SSD. Mental functioning can be better predicted by the DSM-5 diagnosis than by DSM-IV diagnoses. Not the change in single psychological features but in physical functioning during the treatment interval predicted the change in physical functioning until follow-up.

Heartsink Hotel, or “Oh No, Look Who’s on My Schedule this Afternoon!”

Heartsink Hotel, or “Oh No, Look Who’s on My Schedule this Afternoon!”

Subtyping demoralization in the medically ill by cluster analysis

Background and Objectives: There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill. Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis. Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSMIV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder. Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5

ObjectiveCurrent diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample. MethodsUsing a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity. ResultsSeveral features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD. ConclusionsThe present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder.

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder — Comparison with DSM-IV somatoform disorders and additional criteria for consideration

ObjectiveMajor changes to the diagnostic category of somatoform disorders are being proposed for DSM-5. The effect of e.g. the inclusion of psychological criteria (criterion B) on prevalence, predictive validity, and clinical utility of “Somatic Symptom Disorder” (SSD) remains unclear. A prospective study was conducted to compare current and new diagnostic approaches. MethodsIn a sample of N=456 psychosomatic inpatients (61% female, mean age=44.8±10.4years) diagnosed with somatoform, depressive and anxiety disorders, we investigated the current DSM-5 proposal (SSD) plus potential psychological criteria, somatic symptom severity, and health-related quality of life at admission and discharge. ResultsN=259 patients were diagnosed with DSM-IV somatoform disorder (56.8%). With a threshold of 6 on the Whiteley Index to assess psychological criteria, the diagnosis of SSD was similarly frequent (51.8%, N=230). However, SSD was a more frequent diagnosis when we employed the recommended threshold of one subcriterion of criterion B. Patients diagnosed with only SSD but not with DSM-IV somatoform disorder showed greater psychological impairment. Both diagnoses similarly predicted physical functioning at discharge. Bodily weakness and somatic and psychological attributions at admission were among significant predictors of physical functioning at discharge. Reduction of health anxiety, bodily weakness, and body scanning significantly predicted an improvement of physical functioning. ConclusionsPsychological symptoms enhance predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder compared to DSM-IV somatoform disorders. The SSD diagnosis identifies more psychologically impaired patients than its DSM-IV precursor. The currently suggested diagnostic threshold for criterion B might increase the disorder's prevalence.

One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders

BackgroundIn order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis. MethodA stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness. ResultsBodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1–96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%. ConclusionBodily distress syndrome seem to cover most of the relevant “somatoform” or “functional” syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

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

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

An Integrative Approach to Somatoform Disorders Combining Interpersonal and Cognitive-behavioral Theory and Techniques

Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.

Alexithymia and anxiety in female chronic pain patients

ObjectivesAlexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain) female patients and to examine the relationship between alexithymia and the self-reporting of pain.MethodsThirty adult females (mean age: 34,63 ± 10,62 years), who applied to the outpatient psychiatry clinic at a public hospital with the diagnosis of chronic pain disorder (DSM-IV), were included in the study. Thirty seven healthy females (mean age: 34,46 ± 7,43 years), who matched for sociodemographic features with the patient group, consisted the control group. A sociodemographic data form, 26-item Toronto Alexithymia Scale (TAS-26), Spielberger Trait Anxiety Inventory (STAI) were administered to each subject and information was obtained on several aspects of the patients' pain, including intensity (measured by VAS), and duration.ResultsChronic pain patients were found significantly more alexithymic than controls. There was a positive correlation between TAS-26 scores and the duration of pain. The alexithymic and nonalexithymic group did not differ in their perception of pain. Neither positive correlation nor significant difference was found between alexithymia and trait anxiety in pain patients.DiscussionAlexithymia may be important in addressing the diversity of subjective factors involved in pain. The conceptualization of alexithymia as a personality trait as well as a secondary state reaction is underlined by our data.

Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms

Investigators and clinicians almost always rely on Diagnostic and Statistical Manual of Mental Disorder, 4th edition's (DSM-IV) somatoform disorders (and its derivative diagnoses) to characterize and identify patients with medically unexplained symptoms (MUS). Our objective was to evaluate this use by determining the prevalence of DSM-IV somatoform and nonsomatoform disorders in patients with MUS proven by a gold standard chart review. In a community-based staff model HMO, we identified subjects for a clinical trial using a systematic and reliable chart rating procedure among high-utilizing MUS patients. Only baseline data are reported here. The World Health Organization Composite International Diagnostic Interview provided full and abridged DSM-IV diagnoses. Patients with full or abridged DSM-IV somatoform diagnoses were labeled "DSM somatoform-positive," whereas those without them were labeled "DSM somatoform-negative." Two hundred six MUS patients averaged 13.6 visits in the year preceding study, 79.1% were females, and the average age was 47.7 years. We found that 124 patients (60.2%) had a nonsomatoform ("psychiatric") DSM-IV diagnosis of any type; 36 (17.5%) had 2 full nonsomatoform diagnoses, and 41 (19.9%) had >2; 92 (44.7%) had some full anxiety diagnosis and 94 (45.6%) had either full depression or minor depression diagnoses. However, only 9 of 206 (4.4%) had any full DSM-IV somatoform diagnosis, and only 39 (18.9%) had abridged somatization disorder. Thus, 48 (23.3%) were "DSM somatoform-positive" and 158 (76.7%) were "DSM somatoform-negative." The latter exhibited less anxiety, depression, mental dysfunction, and psychosomatic symptoms (all p <.001) and less physical dysfunction (p = .011). Correlates of this DSM somatoform-negative status were female gender (p = .007), less severe mental (p = .007), and physical dysfunction (p = .004), a decreased proportion of MUS (p <.10), and less psychiatric comorbidity (p <.10); c-statistic = 0.77. We concluded that depression and anxiety characterized MUS patients better than the somatoform disorders. Our data suggested radically revising the somatoform disorders for DSM-V by incorporating a new, very large group of now-overlooked DSM somatoform-negative patients who were typically women with less severe dysfunction.

Comorbidities Often Accompany Somatoform Disorders

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessComorbidities Often Accompany Somatoform DisordersJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Jul 2004https://doi.org/10.1176/pn.39.13.0390052At least 1 out of 6 patients seen by general practitioners in the Netherlands has a somatoform disorder—that is, an illness in which no diagnosable general medical condition can fully account for the physical symptoms— a new Dutch study suggests.The study was conducted by Ingrid Arnold, M.D., a general practitioner and researcher at Leiden University Medical Center in the Netherlands, and coworkers and was reported in the June British Journal of Psychiatry.The study was based on a set of questionnaires completed by 1,046 patients seen in eight general medical practices in the Netherlands. Participants completed the SF-36 Functional Limitation Questionnaire as a measure of functional impairment, the Hospital Anxiety and Depression Scale as a measure of anxiety and depression, and the Physical Symptom Checklist to measure the number of reported physical symptoms.Results from these instruments led to the identification of 506 patients at high risk for a somatoform disorder, 404 (80 percent) of whom participated in a psychiatric diagnostic interview. Of the 540 low-risk patients, 82 were invited for the interview, and 69 (84 percent) participated.Results from these interviews were used to identify the kind and number of DSM-IV somatoform disorders as well as any anxiety or depressive disorders that the interviewed subjects had.Of the 404 high-risk subjects interviewed, 116 were found to have a somatoform disorder, 40 an anxiety disorder, and 34 a depressive disorder. Of the 69 low-risk subjects interviewed, three had a somatoform disorder and one an anxiety disorder. The researchers used these data to estimate the prevalence of somatoform disorders as well as the prevalence of anxiety and depression in the entire practice population of 1,046 patients.The prevalence of DSM-IV somatoform disorders was estimated to be about 16 percent, and the most common somatoform disorder was estimated to be undifferentiated somatoform disorder, with a prevalence of 13 percent. Patients with this disorder suffer from one or more unexplained physical symptoms—such as fatigue, headache, or gastrointestinal symptoms—that cause clinically significant distress or impairment for at least six months.In contrast, the prevalence of anxiety and depressive disorders was found to be only 4 percent and 6 percent, respectively.Comorbidity of somatoform disorders and anxiety and depressive disorders, however, appeared to be three times more likely than could have been expected by chance. Of all patients with a somatoform disorder, 26 appeared to also have an anxiety or depressive disorder, and 54 percent of patients with an anxiety or depressive disorder seemed to also have a somatoform disorder.These results, the researchers concluded, suggest that “somatoform disorders are among the most prevalent psychiatric disorders in general practice.” These results, they also pointed out, imply that there is a high comorbidity of somatoform disorders and anxiety and depressive disorders in general medicine practice.The results of the study have implications for general practitioners, Arnold told Psychiatric News. “First, 1 in 6 patients who consult their general practitioner suffers from medically unexplained physical symptoms with substantial impairments. This implies that appropriate treatment options should be developed that are effective in primary care.“Second, half of all patients with anxiety or depression have a comorbid somatoform disorder. Often these physical symptoms are neglected by [general practitioners] since they are considered to be caused by the anxiety or depression... .To engage patients in treatment, we recommend avoiding the counterproductive mind-body dualism that can blame patients and obstruct therapy.”Regarding the implications of these study results for psychiatrists, Arnold added, studies have shown “that cognitive-behavioral therapy [CBT] is effective for somatoform disorders as well as for depressive or anxiety disorders.” Thus, CBT can help “patients with unexplained physical symptoms irrespective of anxiety or depression,” she said.The study was funded by the Netherlands Organization for Health Research and Development.An abstract of the study, “Somatoform Disorders in General Practice,” is posted online at<http://bjp.rcpsych.org/cgi/content/abstract/184/6/470>.▪ The British Journal of Psychiatry 2004 184 470 ISSUES NewArchived

Cognitive-behavioural therapy for patients with multiple somatoform symptoms—a randomised controlled trial in tertiary care

Objective (a) To evaluate the effect of a cognitive-behavioural inpatient treatment and (b) to analyse the differential efficacy of an additional (“soma”) group management training of somatisation. Methods The final sample consisted of 191 patients with somatisation syndrome (patients with at least eight DSM-IV somatoform symptoms). Patients were randomly assigned to (I) “standard treatment+soma” or (II) “standard treatment+relaxation training.” A waiting control group consisted of 34 patients. All patients were diagnosed with a structured clinical interview for DSM-IV and received an interview on medical consulting behaviour and questionnaires concerning somatoform symptoms, general psychopathology, subjective health status, and life satisfaction. Results Results show high impairment of the sample prior to treatment. At the 1-year follow-up, all outcome criteria were significantly reduced. The differential effect of the additional soma treatment was significant only for a reduction of visits to the doctor. Greatest longitudinal effect sizes were found for the reduction of somatoform symptoms. Conclusion Considering the subjects' high initial impairment, the outcome results are encouraging. The specific effect on health care use highlights the socioeconomic relevance.