Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, 20246 Hamburg, Germany.
J Psychosom Res. 2010 May;68(5):403-14. doi: 10.1016/j.jpsychores.2010.01.015. Epub 2010 Mar 12.
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.
为了提高 DSM-V 和 ICD-11 中躯体形式障碍的有效性，目前正在对其进行分类修订。本文比较了目前和几种新的躯体形式障碍诊断建议的有效性和临床实用性，这些诊断建议侧重于无法用医学解释的躯体症状。
我们检索了 Medline、PsycInfo 和 Cochrane 数据库以及相关的参考文献列表。我们纳入了关于躯体形式分类、诊断有效性亚型或单一诊断标准的综述论文和原始文章。
在所有诊断建议中，只有复杂躯体症状障碍和躯体及类似障碍概念问题（CISSD）示例标准反映了躯体化的当前生物心理社会模型的所有维度（构念效度），并且通过纳入特定于躯体化的心理和行为症状（描述性效度）超越了躯体症状的计数。大多数诊断建议的预测效度尚未得到研究。然而，躯体症状的数量已被发现是残疾的一个强有力的预测指标。一些证据表明，心理症状可以预测疾病过程和治疗结果（例如，对灾难化的心理治疗修改与积极结果相关）。冗长的症状清单、对终生症状报告的要求（如简化躯体化障碍）、复杂的症状模式（如当前躯体化障碍）以及诊断程序不精确的定义（例如，复杂躯体症状障碍中缺失症状阈值）降低了临床实用性。
综述研究结果表明，在目前和新的诊断建议中，复杂躯体症状障碍和 CISSD 定义在有效性和临床实用性方面似乎具有优势。纳入心理和行为标准可以提高构念和描述性效度，并赋予前瞻性相关的治疗意义。采用反映躯体和心理症状严重程度的维度方法也有可能提高预测效度和临床实用性。
