Porcelli P, De Carne M, Fava G A
Psychosomatic Unit, Scientific Institute of Gastroenterology, Castellana Grotte, Bari, Italy.
Psychother Psychosom. 2000 Jul-Aug;69(4):198-204. doi: 10.1159/000012394.
Psychiatric assessment of somatization (the tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for them) currently rests on DSM criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. The aim of this study was to compare these new criteria (Diagnostic Criteria for Psychosomatic Research, DCPR) with DSM-IV in a population where a high prevalence of psychosocial problems is expected (functional gastrointestinal disorders, FGID).
One hundred and ninety consecutive patients with FGID in a tertiary care center were assessed according to DSM-IV and DCPR criteria.
The number of the 12 DCPR diagnoses was almost double that of DSM diagnoses. Only 9% of the patients were not identified by DCPR criteria, whereas this occurred in 25% of patients using DSM criteria. While patients who were given a DSM diagnosis frequently had additional DCPR diagnoses, many patients with DCPR syndromes did not fulfill any DSM criteria. Four DCPR syndromes appared to be particularly frequent and accounted for almost three quarters of the total diagnoses (alexithymia, persistent somatization, functional symptoms secondary to a psychiatric disorder, demoralization).
The joint use of DSM and DCPR criteria was found to improve the identification of psychological factors in FGID. The results may pave the way for changes in DSM classification of somatoform disorders.
目前，对躯体化（即倾向于以身体症状的形式体验和表达心理困扰并为此寻求医疗帮助）的精神病学评估基于《精神疾病诊断与统计手册》（DSM）标准。一个国际心身研究小组提出了另一种诊断和概念框架。本研究的目的是在一个预计社会心理问题患病率较高的人群（功能性胃肠疾病，FGID）中，将这些新标准（心身研究诊断标准，DCPR）与DSM-IV进行比较。
在一家三级护理中心，根据DSM-IV和DCPR标准对190例连续的FGID患者进行评估。
DCPR的12种诊断数量几乎是DSM诊断数量的两倍。只有9%的患者未被DCPR标准识别，而使用DSM标准时这一比例为25%。虽然被给予DSM诊断的患者经常有额外的DCPR诊断，但许多患有DCPR综合征的患者不符合任何DSM标准。四种DCPR综合征似乎特别常见，占总诊断的近四分之三（述情障碍、持续性躯体化、继发于精神障碍的功能性症状、士气低落）。
发现联合使用DSM和DCPR标准可改善FGID中心理因素的识别。这些结果可能为DSM中躯体形式障碍的分类变化铺平道路。
