Löwe Bernd, Mundt Christoph, Herzog Wolfgang, Brunner Romuald, Backenstrass Matthias, Kronmüller Klaus, Henningsen Peter
Department of Psychosomatic and General Internal Medicine, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Psychopathology. 2008;41(1):4-9. doi: 10.1159/000109949. Epub 2007 Oct 18.
The impending revisions of DSM-IV and ICD-10 provide an excellent opportunity to improve the diagnostic accuracy of the current somatoform disorder classification. To prepare for these revisions, this study systematically investigates the validity of the current classification of somatoform disorders.
We searched Medline, Psycinfo and reference lists to investigate convergent, divergent, criterion and predictive validity of the current somatoform disorder classification.
Substantial associations of somatoform disorders with functional impairment and elevated health care costs give evidence for the clinical and societal importance of somatoform disorders and for the convergent validity of the current operationalization. The specificity of the current somatoform disorder classification, i.e. their divergent validity, is demonstrated by the fact that functional somatic syndromes and their consequences are only partially explained by association with anxiety and depression. However, the imprecision of the diagnostic criteria, which are not based on positive criteria but on the exclusion of organic disease, largely limits the criterion validity of the current classification systems. Finally, studies investigating the predictive potential of somatoform disorders are lacking, and to date predictive validity has to be considered as low.
The insufficient criterion and predictive validity of the present somatoform classification underlines the need to revise the diagnostic criteria. However, an abolishment of the whole category of somatoform disorders would ignore the substantial convergent and divergent validity of the current classification and would exclude patients with somatoform symptoms from the current health care system. A careful revision of the current somatoform disorder diagnoses, based on positive criteria of psychological, biological and social features, has the potential to substantially improve the reproducibility and clinical utility of the existing classification system.
《精神疾病诊断与统计手册》第四版（DSM-IV）和《国际疾病分类》第十版（ICD-10）即将进行修订，这为提高当前躯体形式障碍分类的诊断准确性提供了绝佳机会。为准备这些修订，本研究系统地调查了当前躯体形式障碍分类的有效性。
我们检索了医学文献数据库（Medline）、心理学文摘数据库（Psycinfo）及参考文献列表，以研究当前躯体形式障碍分类的聚合效度、区分效度、标准效度和预测效度。
躯体形式障碍与功能损害及医疗费用增加之间存在显著关联，这证明了躯体形式障碍在临床和社会层面的重要性以及当前操作化定义的聚合效度。当前躯体形式障碍分类的特异性，即其区分效度，体现在功能性躯体综合征及其后果仅部分可通过与焦虑和抑郁的关联来解释这一事实上。然而，诊断标准不基于阳性标准而是基于排除器质性疾病，这种不精确性在很大程度上限制了当前分类系统的标准效度。最后，缺乏对躯体形式障碍预测潜力的研究，迄今为止预测效度被认为较低。
当前躯体形式障碍分类的标准效度和预测效度不足凸显了修订诊断标准的必要性。然而，完全废除躯体形式障碍这一类别将忽视当前分类的显著聚合效度和区分效度，并且会将有躯体形式症状的患者排除在当前医疗体系之外。基于心理、生物和社会特征的阳性标准对当前躯体形式障碍诊断进行仔细修订，有可能大幅提高现有分类系统的可重复性和临床实用性。
