Spitzer Carsten, Barnow Sven, Wingenfeld Katja, Rose Matthias, Löwe Bernd, Grabe Hans Joergen
University Department of Psychosomatic Medicine and Psychotherapy, University Clinic Hamburg-Eppendorf and Klinikum Eilbek (Schön Kliniken), Hamburg, Germany.
Aust N Z J Psychiatry. 2009 Jan;43(1):80-6. doi: 10.1080/00048670802534366.
Given the association between severe childhood trauma, adult somatization and complex post-traumatic stress disorder (cPTSD), the purpose of the present paper was to assess this syndrome and its clinical correlates in patients with somatization disorder (SD).
A total of 28 patients (82% women, mean age = 41.7+/-10.1 years) meeting DSM-IV criteria for SD as confirmed by the Structured Clinical Interview for DSM-IV, Axis I were compared to 28 age- and gender-matched patients with major depression, but without a lifetime diagnosis of SD. They completed the Structured Interview for Disorders of Extreme Stress, the Brief Symptom Inventory, the Inventory of Interpersonal Problems-Circumplex Scales, and the SF-36 Health Survey.
Compared to the control group, SD patients had higher risks for current and lifetime diagnoses of cPTSD (odds ratio (OR) = 15.0, 95% confidence interval (CI) = 1.76-127.54; and OR = 8.33, 95%CI = 2.04-34.07, respectively). SD subjects with cPTSD had more psychological distress, more interpersonal problems and worse psychosocial functioning than those without the syndrome.
The concept of complex PTSD may hold clinical utility when applied to SD patients because it identifies a distinct subgroup characterized by severe psychosocial impairment. The diagnostic and therapeutic implications of the present findings are discussed.
鉴于儿童期严重创伤、成人躯体化与复杂性创伤后应激障碍（cPTSD）之间的关联，本文旨在评估躯体化障碍（SD）患者中的这种综合征及其临床相关因素。
通过《精神疾病诊断与统计手册》第四版（DSM-IV）轴I障碍的结构化临床访谈确诊的28例符合DSM-IV标准的SD患者（82%为女性，平均年龄 = 41.7±10.1岁）与28例年龄和性别匹配的重度抑郁症患者进行比较，这些抑郁症患者终生未被诊断为SD。他们完成了《极端应激障碍结构化访谈》《简明症状量表》《人际问题环形量表》和《SF-36健康调查》。
与对照组相比，SD患者当前和终生诊断为cPTSD的风险更高（优势比（OR）分别为15.0，95%置信区间（CI） = 1.76 - 127.54；以及OR = 8.33，95%CI = 2.04 - 34.07）。患有cPTSD的SD患者比未患该综合征的患者有更多的心理困扰、更多的人际问题和更差的心理社会功能。
当应用于SD患者时，复杂性创伤后应激障碍的概念可能具有临床实用性，因为它识别出了一个以严重心理社会损害为特征的独特亚组。本文讨论了这些发现的诊断和治疗意义。
