Simon G E, Gureje O
Center for Health Studies, Group Health Cooperative, Seattle, Wash 98101-1448, USA.
Arch Gen Psychiatry. 1999 Jan;56(1):90-5. doi: 10.1001/archpsyc.56.1.90.
Diagnostic criteria for somatization disorder emphasize its early onset and long-term stability. Research assessments of somatization disorder depend on lifetime recall of medically unexplained somatic symptoms.
Longitudinal data from the World Health Organization Psychological Problems in General Health Care study were used to examine stability of somatization disorder and somatization symptoms over 12 months. At 15 study sites in 14 countries, consecutive primary care patients (N = 25916) were screened using the 12-item General Health Questionnaire. A stratified random sample (n = 5447) was selected for a baseline diagnostic assessment using the Composite International Diagnostic Interview. All cases and a random sample of noncases were asked to complete a follow-up diagnostic assessment 12 months later (n = 3196).
While the baseline and 12-month interviews identified a similar number of patients with DSM-IV somatization disorder (74 and 70), only 21 cases were consistently identified at both assessments. Examination of individual symptoms found that 61% of lifetime medically unexplained somatic symptoms detected at baseline were not detected during the lifetime interview 12 months later. When analyses were broadened to all lifetime symptoms reported at baseline (including those found to be "medically explained" or "not clinically significant"), 43% of lifetime symptoms reported at baseline were "lost" 12 months later.
Given that the baseline and follow-up assessments both asked about lifetime symptoms, the loss of somatization disorder or individual somatic symptoms can only represent inconsistent recall. The instability of recall observed here has significant implications for the diagnosis of somatization disorder by structured interview and may also have implications for current diagnostic criteria.
躯体化障碍的诊断标准强调其起病早且具有长期稳定性。对躯体化障碍的研究评估依赖于对医学上无法解释的躯体症状的终生回忆。
利用世界卫生组织“普通医疗保健中的心理问题”研究的纵向数据，考察躯体化障碍及躯体化症状在12个月内的稳定性。在14个国家的15个研究地点，使用12项一般健康问卷对连续的初级保健患者（N = 25916）进行筛查。选取一个分层随机样本（n = 5447），使用复合国际诊断访谈进行基线诊断评估。所有病例及非病例的随机样本被要求在12个月后完成一次随访诊断评估（n = 3196）。
虽然基线访谈和12个月后的访谈识别出的符合《精神疾病诊断与统计手册》第四版（DSM-IV）躯体化障碍的患者数量相近（分别为74例和70例），但两次评估中始终被识别出的病例仅21例。对个体症状的检查发现，基线时检测到的终生医学上无法解释的躯体症状中，61%在12个月后的终生访谈中未被检测到。当分析范围扩大到基线时报告的所有终生症状（包括那些被发现“有医学解释”或“无临床意义”的症状）时，基线时报告的终生症状中有43%在12个月后“消失”了。
鉴于基线评估和随访评估均询问了终生症状，躯体化障碍或个体躯体症状的消失只能代表回忆不一致。此处观察到的回忆不稳定性对通过结构化访谈诊断躯体化障碍具有重要意义，也可能对当前的诊断标准产生影响。
