Schmidt A J
Department of Medical Psychology, University of Limburg, Maastricht, The Netherlands.
Compr Psychiatry. 1994 Jul-Aug;35(4):306-15. doi: 10.1016/0010-440x(94)90024-8.
This review deals with diagnostic problems in DSM-III-R hypochondriasis. A first category of problems is directly connected with the definition of hypochondriasis. The following topics are discussed: the distinction between hypochondriasis and hypochondriacal attitude, the personality aspects of hypochondriasis, and the role of medical findings in the diagnosis. This is followed by a discussion of problems as to the distinction between hypochondriasis and related disorders. This concerns the status of hypochondriasis as a primary or secondary disorder in depression and the relationship with anxiety disorders (especially panic disorder and obsessive-compulsive disorder [OCD]) and the somatization disorder. The DSM-III-R classification of hypochondriasis as a somatoform disorder is disputed. A third category of problems lies in the measurement of hypochondriasis. The scope and quality of the most frequently used questionnaires for measuring hypochondriasis are poor. In research, on the basis of a single questionnaire and without due consideration of medical findings, the diagnosis of hypochondriasis is applied too soon. Finally, it is briefly indicated that the lack of diagnostic clarity affects the way in which the patient is approached in clinical practice.
本综述探讨了《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中疑病症的诊断问题。第一类问题与疑病症的定义直接相关。讨论了以下主题：疑病症与疑病态度的区别、疑病症的人格方面以及医学检查结果在诊断中的作用。接下来讨论了疑病症与相关障碍的区别问题。这涉及疑病症在抑郁症中作为原发性或继发性障碍的地位，以及与焦虑症（尤其是惊恐障碍和强迫症[OCD]）和躯体化障碍的关系。DSM-III-R将疑病症归类为躯体形式障碍存在争议。第三类问题在于疑病症的测量。用于测量疑病症的最常用问卷的范围和质量都很差。在研究中，仅基于单一问卷且未充分考虑医学检查结果，就过早地做出疑病症的诊断。最后，简要指出诊断不明确会影响临床实践中对待患者的方式。
