Gureje Oye, De Guzman Maria Lourdes Rosanna, Khaled Salma M, Ni Michael Y, Woodruff Peter W, Reed Geoffrey M, Wong Corine S M, Leung Candi M C, Crisostomo Marilyn, Borowski Shelby, Hwang Irving, Petukhova Maria V, Sampson Nancy, Kessler Ronald C
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
World Psychiatry. 2025 Oct;24(3):395-403. doi: 10.1002/wps.21353.
Distressing somatic symptoms are common and disabling, but a lack of reliable classification of the underlying disorders has limited our understanding of the extent of their population burden. The new categories of bodily distress disorder (BDD) in the ICD-11 and somatic symptom disorder (SSD) in the DSM-5 were designed to address the fundamental weaknesses of previous conceptualizations, but have important differences in their criteria specifications. Three new large-scale population surveys within the World Mental Health (WMH) Survey Initiative, conducted in socially and culturally diverse settings, provide the opportunity to address questions regarding population prevalence, mental and physical health correlates, and associations with role impairment of BDD and SSD. WMH surveys were carried out in representative household samples of adults in Hong Kong, the Philippines, and Qatar (combined N=18,105 respondents). Multivariable regression analysis examined associations of BDD and SSD with socio-demographic variables, comorbid DSM-5 mental disorders, and chronic physical conditions. Role impairment was assessed by examining the mean number of health-related days out of role (DOR) in the 30 days before the interview, adjusting for socio-demographic variables and comorbidities. The point prevalence across the three settings was 2.0% for BDD, 3.5% for SSD, and 4.1% for either diagnosis. The point prevalence of BDD and especially of SSD was highest in Hong Kong, suggesting a role of cultural and social factors. Females were twice as likely as males to meet the criteria for either disorder. Prevalence increased with age. BDD and SSD were significantly associated with generalized anxiety, panic, post-traumatic stress, major depressive, and bipolar spectrum disorders, and associations were consistently stronger for BDD than SSD. More modest comorbidities were found with common chronic physical conditions (arthritis, asthma, diabetes mellitus, hypertension, and stomach or intestinal ulcer). BDD and SSD were both significantly associated with increased mean DOR after adjusting for comorbid mental disorders and chronic physical conditions, but the adjusted mean DOR was significantly higher in the BDD-only than in the SSD-only subsample (4.7 vs. 3.1, p<0.001). These findings attest to the high public health importance of BDD and SSD. Even though both are not highly prevalent in the community, their co-occurrence with common physical and mental disorders, and the fact that they are associated significantly with role impairment, provide strong reason for clinical attention.
令人苦恼的躯体症状很常见且会导致功能障碍，但潜在疾病缺乏可靠分类限制了我们对其人群负担程度的理解。《国际疾病分类第11版》中的身体苦恼障碍（BDD）和《精神疾病诊断与统计手册第5版》中的躯体症状障碍（SSD）这两个新类别旨在解决先前概念化的根本弱点，但在标准规范上有重要差异。世界心理健康（WMH）调查倡议开展的三项新的大规模人群调查在社会和文化背景多样的环境中进行，为解决有关BDD和SSD的人群患病率、心理和身体健康相关因素以及与角色功能损害的关联等问题提供了机会。WMH调查在香港、菲律宾和卡塔尔的成年代表性家庭样本中进行（总计N = 18105名受访者）。多变量回归分析检验了BDD和SSD与社会人口统计学变量、共病的《精神疾病诊断与统计手册第5版》精神障碍以及慢性身体疾病之间的关联。通过检查访谈前30天内与健康相关的角色缺失天数（DOR）的平均数来评估角色功能损害，并对社会人口统计学变量和共病情况进行调整。三种环境下的时点患病率分别为：BDD为2.0%，SSD为3.5%，两种诊断之一为4.1%。BDD尤其是SSD的时点患病率在香港最高，表明文化和社会因素起到了作用。女性符合任一障碍标准的可能性是男性的两倍。患病率随年龄增长而增加。BDD和SSD与广泛性焦虑、惊恐、创伤后应激、重度抑郁和双相谱系障碍显著相关，且BDD的相关性始终比SSD更强。与常见慢性身体疾病（关节炎、哮喘、糖尿病、高血压以及胃或肠道溃疡）的共病情况较少。在对共病精神障碍和慢性身体疾病进行调整后，BDD和SSD均与平均DOR增加显著相关，但仅患有BDD的亚组调整后的平均DOR显著高于仅患有SSD的亚组（4.7对3.1，p<0.001）。这些发现证明了BDD和SSD对公共卫生具有高度重要性。尽管两者在社区中都不十分普遍，但它们与常见身心障碍同时出现，并且与角色功能损害显著相关，这为临床关注提供了充分理由。
