Somatization: a spectrum of severity.

Area of Science:

• Psychiatry
• Primary Care Medicine

Background:

• The diagnosis of somatization disorder in the DSM-III-R relies on a specific number of medically unexplained somatic symptoms, determined by committee consensus.
• It remains unclear if patients meeting this threshold are distinctly different from those with fewer, yet substantial, somatic symptoms.

Purpose of the Study:

• To investigate whether patients with a specific number of medically unexplained somatic symptoms can be differentiated from those with lower symptom counts.
• To explore the clinical and behavioral features across a spectrum of somatization symptom severity.

Main Methods:

• 119 distressed high utilizers of primary care clinics, identified via screening or physician referral, completed the Diagnostic Interview Schedule (DIS).
• Participants were categorized into four groups based on the number of unexplained somatic symptoms identified by the DIS.
• These groups were compared across demographic, psychiatric distress, disability, medical, and healthcare utilization variables.

Main Results:

• Clinical and behavioral features of somatization were significantly more prevalent in patients with four to 12 medically unexplained somatic symptoms, rather than showing a sharp change at the diagnostic threshold.
• Patients meeting DSM-III-R criteria for somatization disorder exhibited severe illness and a high burden of psychiatric comorbidity and disability.

Conclusions:

• The findings suggest that somatization disorder exists on a spectrum, with features present across a range of symptom counts.
• The study recommends that the DSM-IV somatoform disorders classification should encompass somatization disorder, a related condition with anxiety/depression, and somatization linked to adjustment disorder.