Institute of Psychology.
Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University.
J Clin Gastroenterol. 2021 Sep 1;55(8):e66-e76. doi: 10.1097/MCG.0000000000001505.
The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics.
This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients.
About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits.
Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.
目前躯体症状障碍（SSD）的诊断概念旨在捕捉因躯体主诉而产生的心理负担，而不考虑其医学病因。本研究旨在比较伴有 SSD（SSD+）和不伴 SSD（SSD-）的慢性胃肠道（GI）主诉患者的社会人口学、临床和心理特征。
这项横断面研究纳入了 199 名（n=92 SSD+和 n=107 SSD-）有令人痛苦的慢性腹部/下 GI 主诉（≥6 个月）的患者，他们来自多个初级、二级和三级医疗保健单位。通过心理行为阳性标准将 SSD+患者与 SSD-患者区分开来。测量了心理困扰（躯体化、抑郁、焦虑和疾病焦虑）和风险因素（不良童年经历、不安全依恋、心理化能力和人格功能水平）。进行了非参数组间比较，以分析 SSD+和 SSD-患者在社会人口学、临床和心理特征方面的差异。
大约一半的 SSD+患者有功能性 GI 障碍，三分之一的患者有炎症性肠病。SSD+患者报告的 GI 疼痛严重程度更高，健康相关和工作相关的损害程度更高，心理困扰更高，尤其是疾病焦虑，以及心理化和人格功能缺陷更高。
总体而言，SSD 的心理行为阳性标准似乎是一个识别表现出高心理负担的患者的有效指标，而与 GI 主诉的医学解释无关。SSD 与一般心理负担有很大的重叠，但也有证据表明存在特定的疾病实体。
