This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (156)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care

Kurt Kroenke, MD; Robert L. Spitzer, MD; Frank V. deGruy III, MD; Steven R. Hahn, MD; Mark Linzer, MD; Janet B. W. Williams, DSW; David Brody, MD; Mark Davies, MS

Arch Gen Psychiatry. 1997;54(4):352-358.

Abstract
Background
For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (2 years) history of somatization.

Methods
Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; selfreported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter.

Results
Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were enrolled in the Primary Care Evaluation of Mental Disorders Study. Compared with mood and anxiety disorders, multisomatoform disorder was associated with comparable impairment in health-related quality of life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty.

Conclusions
Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.

Author Affiliations
From the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Drs Spitzer and Williams and Mr Davies); Department of Family Practice, University of South Alabama College of Medicine, Mobile (Dr deGruy); and Departments of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (Dr Hahn), University of Wisconsin Medical School, Madison (Dr Linzer), and Medical College of Pennsylvania and Hahnemann University, Philadephia (Dr Brody).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Psychobehavioral Predictors of Somatoform Disorders in Patients With Suspected Allergies
Hausteiner et al.
Psychosom. Med. 2009;71:1004-1011.
ABSTRACT | FULL TEXT  

Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
Kroenke
Focus 2009;7:414-423.
ABSTRACT | FULL TEXT  

Diagnostic Accuracy of Predicting Somatization From Patients' ICD-9 Diagnoses
Smith et al.
Psychosom. Med. 2009;71:366-371.
ABSTRACT | FULL TEXT  

Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: A 5-Year Follow-up Study
Jackson and Kroenke
Psychosom. Med. 2008;70:430-434.
ABSTRACT | FULL TEXT  

Overlap, Comorbidity, and Stability of Somatoform Disorders and the Use of Current Versus Lifetime Criteria
Leiknes et al.
Psychosomatics 2008;49:152-162.
ABSTRACT | FULL TEXT  

A Reconceptualization of the Somatoform Disorders
Noyes et al.
Psychosomatics 2008;49:14-22.
ABSTRACT | FULL TEXT  

Stability of Somatoform Symptoms Implications for Classification
Rief and Rojas
Psychosom. Med. 2007;69:864-869.
ABSTRACT | FULL TEXT  

Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
Kroenke
Psychosom. Med. 2007;69:881-888.
ABSTRACT | FULL TEXT  

Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations
Kroenke et al.
Psychosomatics 2007;48:277-285.
ABSTRACT | FULL TEXT  

Ratings of Physician Communication by Real and Standardized Patients
Fiscella et al.
Ann Fam Med 2007;5:151-158.
ABSTRACT | FULL TEXT  

Symptoms and Syndromes of Bodily Distress: An Exploratory Study of 978 Internal Medical, Neurological, and Primary Care Patients
Fink et al.
Psychosom. Med. 2007;69:30-39.
ABSTRACT | FULL TEXT  

Physicians' responses to patients' medically unexplained symptoms.
Epstein et al.
Psychosom. Med. 2006;68:269-276.
ABSTRACT | FULL TEXT  

Symptoms and Related Functioning in a Traumatized Community
van den Berg et al.
Arch Intern Med 2005;165:2402-2407.
ABSTRACT | FULL TEXT  

USE OF PSYCHOPHARMACOLOGICAL AGENTS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
Clouse and Lustman
Gut 2005;54:1332-1341.
FULL TEXT  

Somatization Increases Medical Utilization and Costs Independent of Psychiatric and Medical Comorbidity
Barsky et al.
Arch Gen Psychiatry 2005;62:903-910.
ABSTRACT | FULL TEXT  

Somatoform Disorders: Time for a New Approach in DSM-V
Mayou et al.
Am. J. Psychiatry 2005;162:847-855.
ABSTRACT | FULL TEXT  

Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms
Smith et al.
Psychosom. Med. 2005;67:123-129.
ABSTRACT | FULL TEXT  

Treatment of Somatoform Disorders With St. John's Wort: A Randomized, Double-Blind and Placebo-Controlled Trial
Muller et al.
Psychosom. Med. 2004;66:538-547.
ABSTRACT | FULL TEXT  

Somatoform disorders in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders
De Waal et al.
Br. J. Psychiatry 2004;184:470-476.
ABSTRACT | FULL TEXT  

Reliability of self-reported diagnoses in patients with neurologically unexplained symptoms
Schrag et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:608-611.
ABSTRACT | FULL TEXT  

Somatoform Disorders in DSM-V
Mayou et al.
Psychosomatics 2003;44:449-451.
FULL TEXT  

A Randomized Clinical Trial of a Care Recommendation Letter Intervention for Somatization in Primary Care
Dickinson et al.
Ann Fam Med 2003;1:228-235.
ABSTRACT | FULL TEXT  

"Free-Floating" Somatoform Disorder
Tofler
Psychosomatics 2003;44:435-436.
FULL TEXT  

Specific Somatoform Disorder in the General Population
Grabe et al.
Psychosomatics 2003;44:304-311.
ABSTRACT | FULL TEXT  

Psychosocial Treatments for Multiple Unexplained Physical Symptoms: A Review of the Literature
Allen et al.
Psychosom. Med. 2002;64:939-950.
ABSTRACT | FULL TEXT  

Multiple Idiopathic Physical Symptoms in the ECA Study:Competing-Risks Analysis of 1-Year Incidence, Mortality, and Resolution
Engel et al.
Am. J. Psychiatry 2002;159:998-1004.
ABSTRACT | FULL TEXT  

Somatisation in primary care
Pennebaker et al.
BMJ 2002;324:544-544.
FULL TEXT  

The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke et al.
Psychosom. Med. 2002;64:258-266.
ABSTRACT | FULL TEXT  

Somatization: A Critical Review of Conceptual and Methodological Issues
De Gucht and Fischler
Psychosomatics 2002;43:1-9.
ABSTRACT | FULL TEXT  

Somatization Symptoms and Hypochondriacal Features in the General Population
Rief et al.
Psychosom. Med. 2001;63:595-602.
ABSTRACT | FULL TEXT  

Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists
BASS et al.
Br. J. Psychiatry 2001;179:11-14.
ABSTRACT | FULL TEXT  

Medically Unexplained Symptoms in an Urban General Medicine Practice
Feder et al.
Psychosomatics 2001;42:261-268.
ABSTRACT | FULL TEXT  

The Stability of Somatization Syndromes Over Time
Gara et al.
Arch Gen Psychiatry 2001;58:94-94.
FULL TEXT  

Consultation-Liaison Psychiatrists' Management of Somatoform Disorders
Smith et al.
Psychosomatics 2000;41:481-489.
ABSTRACT | FULL TEXT  

Chronic Pain Disorder Following Physical Injury
Streltzer et al.
Psychosomatics 2000;41:227-234.
ABSTRACT | FULL TEXT  

Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients
Keeley et al.
Arch Fam Med 2000;9:46-54.
ABSTRACT | FULL TEXT  

Childhood Risk Factors for Adults With Medically Unexplained Symptoms: Results From a National Birth Cohort Study
Hotopf et al.
Am. J. Psychiatry 1999;156:1796-1800.
ABSTRACT | FULL TEXT  

An International Study of the Relation between Somatic Symptoms and Depression
Simon et al.
NEJM 1999;341:1329-1335.
ABSTRACT | FULL TEXT  

Somatization in Primary Care: Prevalence, Health Care Utilization, and General Practitioner Recognition
Fink et al.
Psychosomatics 1999;40:330-338.
ABSTRACT | FULL TEXT  

Stability of Somatization Disorder and Somatization Symptoms Among Primary Care Patients
Simon and Gureje
Arch Gen Psychiatry 1999;56:90-95.
ABSTRACT | FULL TEXT  

The Value of Screening for Psychiatric Disorders in Rheumatology Referrals
O'Malley et al.
Arch Intern Med 1998;158:2357-2362.
ABSTRACT | FULL TEXT  

Multisomatoform Disorder
Fava et al.
Arch Gen Psychiatry 1998;55:756-757.
FULL TEXT  

A Symptom Checklist to Screen for Somatoform Disorders in Primary Care
Kroenke et al.
Psychosomatics 1998;39:263-272.
ABSTRACT | FULL TEXT