6533b872fe1ef96bd12d3ac0

RESEARCH PRODUCT

Don't change a winning horse

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IntroductionThere is surprising excitement about the adequacy andfuture of the somatoform disorders (SFDs) as a circum-scribed diagnostic group [1–4]. Some authors wish to takethe forthcoming fifth revision of the Diagnostic andStatistical Manual (DSM) as a welcome occasion to removean unloved diagnostic term. However, eliminating the SFDswould devaluate the progress of research and clinicalpractice made during the past 25 years. It would lead toinsecurity and confusion in an interdisciplinary field whereclear terminology and common understanding is of highvalue. This contribution attempts to summarize some of themajor reasons why DSM-V should continue with the SFDs.Some suggestions will be made on how to improve andrefine the current system.Advantages of the current classificationDiagnostic categories are indispensableSymptoms, syndromes, and diagnoses represent threeseparate diagnostic levels. The term bmedically unexplainedsomatic symptomsQ refers to the symptom level. A group ofcharacteristic symptoms constitutes a syndrome. For exam-ple, low mood, loss of energy, sleep disturbance, concen-tration difficulties, and related symptoms constitute adepressive syndrome. Analogously, a group of coexistingmedically unexplained (somatoform) symptoms can beconsidered a somatoform syndrome. Diagnoses go one stepfurther and add inclusion and exclusion criteria, minimumduration, or severity definitions (e.g., in terms of psychoso-cial impairment). Therefore, a description on symptom levelcannot replace a diagnosis. The presence of symptoms doesnot necessarily imply that the person also fulfills the criteriaof a diagnosis.bSomatoformQ is an ideal term to label medicallyunexplained somatic symptomsThe term bsomatoformQ communicates that the clinicalcondition initially suggests the existence of a somaticdisease that is, however, afterward ruled out throughappropriate medical examination. Only the outer appearanceand not the real existence of somatic disease is indicated.Comparable examples from the field of the mental disordersare bmaniformQ (manic symptomatology not sufficient tofulfill the criteria of a manic or hypomanic episode) andbschizophreniformQ (typical symptoms of schizophrenia butnot persistent enough). The term bsomatoform disorderQ canbe explained easily to patients and is not associated withnegative stigma.SFD should be considered as a mental disorder and not as asomatic diseaseThe core feature of the SFDs is the absence of a knownorganic disease that could explain the somatic symptoms.There is ample evidence that psychological factors suchas perception, cognition, and illness behavior play a centralrole (see, e.g., Barsky’s somatosensory amplification). It isnot decisive whether or not patients see or accept thesepsychological factors. It may be the result of goodtreatment that patients are able to acknowledge thepsychophysiological dimension of their complaints. Behav-ioral treatments currently belong to the most importantand best validated therapies for patients with SFDs [5].Since usual somatic treatment is of limited value, primarycare physicians are trained how to react to the patients’