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Stability of Somatoform Symptoms—Implications for Classification

From the Department of Clinical Psychology and Psychotherapy (W.R.), Philipps University of Marburg, Marburg, Germany; and the Department of Clinical Psychiatry (G.R.), University of Chile, Santiago, Chile.

Address correspondence and reprint requests to Winfried Rief, Clinical Psychology und Psychotherapy, Philipps University of Marburg, Gutenbergstrasse18, D–35032 Marburg, Germany. E-mail: rief{at}staff.uni-marburg.de

ABSTRACT

Objective: To investigate the stability of somatoform symptoms/disorders.

Methods: A literature search was done to select studies reporting data on stability of medically unexplained physical symptoms.

Results: Whereas individual symptoms vary over time, grouping symptoms into syndromes seems to create stable features. There are substantial problems with the use of lifetime diagnosis, favoring classification approaches that require only present state symptoms. Further, doctors’ ratings that symptoms are "medically unexplained" is highly problematic and reduces interrater reliability. Misdiagnoses and overlooking of organic conditions are in the same range as for other psychiatric (and many organic) disorders; therefore, this does not seem to reduce the stability of the diagnoses of somatoform disorders.

Conclusions: These results indicate how the classification of somatoform disorders can be improved. Some new diagnostic criteria are suggested that could be considered in the revision of Diagnostic and Statistical Manual of Mental Disorders—V (DSM-V).

Key Words: somatoform disorder • classification • stability • reliability • misdiagnosis

Abbreviations: DSM = Diagnostic and Statistical Manual of Mental Disorders; TR = Text Revision; ICD = International Classification of Disease; GP = general practitioner

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