[Masked depression: the rise and fall of a diagnosis]

The diagnosis of "masked depression" was very common in the 70'es and 80'es for patients with somatic complaints without an organic counterpart, when a psychic illness was assumed. Today this diagnosis does not play an important role any more - neither clinically nor scientifically. This article examines the background of the enormous initial importance of this diagnostic concept and of its final abandonment.

Critical reflection of the literature.

The main reason for the immense success of that diagnosis was the tempting possibility of subsuming patients with a multitude of only unsatisfactorily explicable and treatable somatic symptoms under one single concept. In addition, this concept allowed to derive a uniform treatment, i.e. pharmacotherapy with antidepressants. Several problems inherent in the diagnosis of masked depression finally led to the dropping of that concept: the expansion of that diagnosis onto a vast number of disorders, the continuing lack of clarity of the concept (disorder of recognition vs. disorder of communication; the positive proof of psychic symptoms as a prerequisite vs. the positive proof of psychic symptoms as an exclusion criterion for that diagnosis). Last but not least, the introduction of DSM-III and ICD-10 as operationalized, purely descriptive and rather theory-free systems of diagnostic classification supported that development.

The present diagnoses for those patients re-emphasize the somatic symptomatology. Formerly "masked depressed" patients are now diagnosed as suffering from somatization disorder, somatoform disorder, psychosomatic disorder, conversion disorder, neurasthenia or hypochondriasis.