From the Department of Psychosomatic Medicine and Psychotherapy (Sattel, Henningsen, Hausteiner-Wiehle), Technical University of Munich, Munich; Department of Internal Medicine 1 (Häuser), Klinikum Saarbrücken, Saarbrücken; Departments of Medical Psychology and Medical Sociology (Schmalbach) and Psychosomatic Medicine and Psychotherapy (Brähler), University of Mainz, Mainz; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit (Brähler), University of Leipzig Medical Center, Leipzig; and Department of Neurology (Hausteiner-Wiehle), BGTrauma Center Murnau, Murnau, Germany.
Psychosom Med. 2023 May 1;85(4):366-375. doi: 10.1097/PSY.0000000000001187. Epub 2023 Mar 15.
The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known.
We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined.
There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two.
Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.
持续性和麻烦性躯体症状的概念和分类存在差异，这阻碍了对其进行充分的临床管理。功能性躯体障碍（FSD）是一个最近提出的界面概念，具有病因学中性的特点，并允许出现功能失调的心理行为特征以及躯体共病。然而，其患病率和影响尚不清楚。
我们使用操作性 FSD 标准分析了来自一项具有代表性的德国社区调查的 2379 名参与者（平均年龄=48.3 岁，52.5%为女性）。这些标准根据躯体痛苦综合征检查表评估的躯体症状数量、类型和严重程度来定义 FSD 类型。此外，还确定了这些类型与健康问题、共病、心理困扰和自我报告的健康之间的关联。
有四个明显划分的组别，没有相关的困扰症状，一个或一个以上器官系统有少数困扰症状，至少两个器官系统有多个困扰症状。心理困扰、健康问题和共病随着症状数量和严重程度的增加而稳步增加，自我报告的健康状况则随之下降。躯体症状负担、健康问题和共病独立预测自我报告的健康状况，后两者之间没有相互作用。
我们的数据支持 FSD 概念，根据一个或多个器官系统中持续存在和麻烦性症状的严重程度分为两个严重程度等级。具有心理行为特征和/或躯体共病的亚型的划分似乎是有用的，同时仍允许将一组具有高躯体症状负担但没有这些额外特征的参与者进行区分。
