[Missed somatic disease: justified fear or chimera?]

The fear to miss the diagnosis of somatic processes in "functional" disorders and the ignorance of the positive criteria for the diagnosis of conversion (physical expression of conflicts) and of psychophysiological disorder (somatic symptoms and signs, accompanying affectivity) lead to diagnosing by exclusion of somatic disorders. Its consequences are extensive, damaging procedures and a postponement of a diagnosis which integrates somatic, psychic and social components by seven to eight years. Based on positive criteria, which had been collected by means of a bio-psycho-social approach to the patient, ten were diagnosed as suffering from conversion and 22 from psychophysiological disorders. Five years later the patients were reassessed. In none of the cases a somatic diagnosis emerged, which would have been responsible for the initial complaints five years earlier. The diagnoses "conversion" and "psychophysiological disorder" proved to be reliable over five years, if they were based on positive criteria. The fear to miss a somatic process turns thus into a chimera.