Article

Towards positive diagnostic criteria: a systematic review of somatoform disorder diagnoses and suggestions for future classification.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, 20246 Hamburg, Germany.
Journal of psychosomatic research (impact factor: 2.91). 05/2010; 68(5):403-14. DOI:10.1016/j.jpsychores.2010.01.015 pp.403-14
Source: PubMed

ABSTRACT The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms.
We searched the Medline, PsycInfo, and Cochrane databases, as well as relevant reference lists. We included review papers and original articles on the subject of somatoform classification in general, subtypes of validity of the diagnoses, or single diagnostic criteria.
Of all diagnostic proposals, only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria reflect all dimensions of current biopsychosocial models of somatization (construct validity) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated. However, the number of somatic symptoms has been found to be a strong predictor of disability. Some evidence indicates that psychological symptoms can predict disease course and treatment outcome (e.g., therapeutic modification of catastrophizing is associated with positive outcome). Lengthy symptom lists, the requirement of lifetime symptom report (as in abridged somatization), complicated symptom patterns (as in current somatization disorder), and imprecise definitions of diagnostic procedures (e.g., missing symptom threshold in complex somatic symptom disorder) reduce clinical utility.
Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.

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Keywords

behavioral symptoms
 
CISSD definition
 
complex somatic symptom disorder
 
current somatization disorder
 
diagnostic procedures
 
diagnostic proposals
 
dimensional approach
 
Lengthy symptom lists
 
lifetime symptom report
 
medically unexplained somatic symptoms
 
new diagnostic proposals
 
predictive validity
 
prospectively relevant treatment implications
 
psychological symptoms
 
relevant reference lists
 
single diagnostic criteria
 
somatic symptoms
 
somatoform classification
 
symptom threshold
 
treatment outcome