Somatization in Family Practice: Comparing 5 Methods of Classification
Primary Care Companion J Clin Psychiatry 1999;1(3):85-89
© Copyright 2017 Physicians Postgraduate Press, Inc.
Background: It has been suggested that patients
with somatoform disorders are high utilizers of medical care, yet
interpretation of studies has been difficult because of variant
methods of diagnosis. The goal of this study was to compare 5
different methods of classification on the same group of subjects
and to examine prevalence rates of somatoform disorders and
Method: Subjects completed a demographic
questionnaire in the physician's office and the somatization
section of the Diagnostic Interview Schedule (DIS) by telephone.
Subsequently, their medical charts were examined. Using the 5
methods of diagnosis, somatizers were compared with nonsomatizers
for level of utilization of medical services. The setting was a
medical school-based family practice residency training center.
Participants were 119 patients waiting to see their family
doctors. The main outcome measures were prevalence of
somatization symptoms and chart information (utilization, number
of health problems).
Results: One subject met the Diagnostic and
Statistical Manual (DSM-IV)-based DIS criteria for
somatization disorder. With the Bucholz modification for scoring
the DIS, 10 subjects were diagnosed with somatization disorder.
With the abridged Escobar criteria of 6 symptoms, 7 subjects met
diagnostic criteria, while 28 met the criteria for
multisomatoform disorder of 3 symptoms, as suggested by Kroenke.
The diagnosis of undifferentiated somatoform disorder, requiring
only 1 unexplained symptom, was obtained by 94 of the subjects.
Conclusion: Findings from this study revealed
widely divergent prevalence rates of somatoform disorders,
depending on methods of diagnosis used. Correlation with rates of
medical utilization is suggested as an external criterion for
validating diagnostic methods.