Learn more. Relationship and differences between psychosomatic, somatoform and idiopathic disorders Ask Question. Asked 3 years, 2 months ago. Active 1 year, 10 months ago. Viewed 3k times. Psychosomatic disorder psychosomatic adj. American Heritage Dictionary psychosomatic 1.
Psychology of or relating to disorders, such as stomach ulcers, thought to be caused or aggravated by psychological factors such as stress Collins English Dictionary somatoform disorder called somatic symptom disorder since DSM-V denoting physical symptoms that can not be attributed to organic disease and appear to be of psychic origin.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health denoting physical symptoms that cannot be attributed to organic disease and appear to be psychogenic.
Dorland's Medical Dictionary for Health Consumers In both cases these terms seem to be used for physical symptoms which rather than being attributed to physical conditions, are based on mental factors, ie. American Heritage Dictionary From looking at these two meanings of psychosomatic disorder and somatoform disorder, am I mistaken in perceiving them the same way, or at least confusingly almost the same thing?
Improve this question. Chris Rogers Zebrafish Zebrafish 1 1 silver badge 3 3 bronze badges. Add a comment. Active Oldest Votes. Idiopathic, as you pointed out is Of, relating to, or designating a disease having no known cause. Further clarification Psychosomatic is a word describing a somatoform. References Al Busaidi, Z. Improve this answer. Chris Rogers Chris Rogers I take it they're not all idiopathic? The definitions seem to hint at it by saying "appear to be of psychic origin", and "appear to be psychogenic" which seem to imply uncertainty.
I'm not sure if that qualifies for idiopathic. Then again, I could hypothetically imagine a somatoform disorder confidently attributed to major depression, for example, then the cause would be known and would not be idiopathic.
I don't believe anyone considers somatoform disorders to include mental stress, however. The fourth term, that basically means the same, is "functional," for example functional gastrointestinal disorders with emphasis on "brain-gut axis. Two case histories are described, and relevant terms differentiating psychosomatic, somatopsychic, and multisystem illnesses are identified, reviewed, and discussed.
A psychiatric diagnosis cannot be given solely based upon the absence of physical, laboratory, or pathological findings.
The terms subjective, nonspecific, and vague can be used inaccurately. Bodily distress disorder and bodily distress syndrome are scientifically unsupported and inaccurate. Better education concerning the interface between medicine and psychiatry and the associated diagnostic nomenclature as well as utilizing clinical judgment and thorough assessment, exercising humility, and maintaining our roots in traditional medicine will help to improve diagnostic accuracy and patient trust. Many physicians find it challenging when making a diagnosis involving the interface between general medical and psychiatric illnesses, and diagnostic errors harm patients.
Historically, there has been a bias in which poorly understood illnesses are often considered to have a psychiatric origin until the pathophysiology is better understood and explained on some other basis. There is a broad spectrum of opinion regarding how to approach a diagnosis when there is a general medical and psychiatric differential diagnosis [ 1 ]. In recent years, medicine has gravitated towards a pressure to comply with third party guidelines and computerized algorithms, and there has been a trend towards super specialization with limited training in non-specialty fields.
The combination of these issues has collectively contributed to a silo mentality and a fragmentation of knowledge [ 2 ]. These limitations impede the adequacy of the clinical assessment of complex diseases. Knowledge gaps can be associated with several issues: 1 a lack of knowledge in either psychiatry or medicine, 2 gaps between clinical expertise and research knowledge, 3 difficulties converting research results derived from groups of subjects to the uniqueness of individual patients, and 4 the improper application of guidelines.
The average physician who practices in an internal medicine specialty, including many who write guidelines that others follow, may have a very limited basic background in psychiatry, often consisting of a one-month rotation through a state hospital while in medical school, and little continuing medical education in psychiatry or psychosomatic medicine since then.
Although psychiatrists have a strong foundation in general medicine, not all psychiatrists keep current in general medicine, and many other mental health professionals have very limited training in general medicine. With specialization and fragmentation in healthcare systems, there are many healthcare providers lacking capability in both psychiatry and general medicine.
As a result, the understanding of the interface between mental and somatic disorders falls into a gap between psychiatry and medicine. It is a concern when thought leaders lacking adequate knowledge in both psychiatry and general medicine write and promote diagnostic and treatment guidelines that others may then follow rigidly on subjects such as somatoform disorder, somatic symptom disorder, medically unexplained symptoms, bodily distress disorder, and multisystem illnesses.
Another gap exists between clinical expertise and medical research. This can result in difficulty reconciling differences between clinical observation and clinician experience vs. However, more effective progress is achieved when there is also a bidirectional process in which clinical observations and wisdom also inform basic science research.
Most who attended this meeting were not physicians, and the few physicians who attended were academicians and researchers rather than physicians practicing in the community which had higher levels of clinical experience and expertise [ 5 ]. Another limitation occurs when research is performed on groups of individuals, which generate statistics for groups of patients that are then translated into a specific treatment for the individual patient. Patients with unique presentations are being compromised by an emphasis upon population-based standards of care rather than their individual patient needs and experiences.
It is far better for physicians to rely less upon clinical guidelines based upon group statistics for managing single diseases and instead rely more on their own clinical judgment to create treatment plans that are tailored to meet the needs of individual patients [ 6 ]. Diseases involving brain and body interaction are particularly challenging. In view of the uniqueness of individuals, biological heterogeneity, the complexity of some illnesses, and individual differences in treatment tolerance, safety, and efficacy, any treatment based upon rigid adherence to treatment guidelines derived from groups and applied to individual patients without exercising clinical judgment is clearly below the standard of care [ 7 , 8 , 9 ].
As a result of these multiple issues, patients with complex illnesses can feel lost and abandoned by the healthcare system. Complex brain—body differential diagnoses are challenging to payers, physicians, and affected patients. Patients often describe going to many different physicians before they acquire an accurate diagnosis. One survey of over 12, participants found the average patient with Lyme disease was seen by five physicians before they were properly diagnosed [ 10 ].
When the time allowed for a more thorough assessment is limited by healthcare reimbursement policies, physicians often respond by ordering an excessive amount of testing. Healthcare financial resources are strained, since these patients may not fit well into current diagnostic and treatment algorithms, and the evaluations of these patients may result in multiple tests and consultations of limited cost effectiveness [ 11 ].
Diagnostic delays also result in increased costs from disability, lost productivity, and caretaker burden. Many insurance companies have barriers and limitations of what they cover, and patients with complex, chronic, and costly diseases incur significant out-of-pocket costs.
A significant number of medical bankruptcies occur among both insured and uninsured individuals [ 12 , 13 ]. When dealing with these challenging cases, some physicians view these patients as being difficult, frustrating, and demanding [ 14 ]. In addition, some physicians react to these difficult cases by becoming highly stressed [ 15 ].
However, the greatest stress is endured by the patients who report feeling dissatisfied, disbelieved, and dismissed by clinicians [ 16 ]. Brain—body diagnostic errors are common in these patients, and these errors receive considerable attention in both the media and in the medical literature. Most of the cases receive this attention in books, media, and journal articles and involve erroneous psychiatric diagnoses rather than medical diagnoses [ 17 , 18 ].
There are many reported cases of misdiagnosis and treatment delays in the media. One case that drew considerable media attention was the case of Julia, who was in a wheelchair from Lyme disease and was blessed by the Pope when he visited Philadelphia. Two psychiatrists independently cleared Julia of any psychological cause for her symptoms.
The attending pediatrician refused to accept either report. To rule out her suspicion of malingering, she had the physical therapist purposely drop Julia on the concrete floor [ 20 , 21 , 22 ].
An example of misdiagnosis reported in the medical literature is the case of a year-old woman with pain and discomfort in multiple sites on her upper body. She was diagnosed with somatic symptom disorder after a partial examination turned out to be negative.
Falsely diagnosed as having somatic symptom disorder for six months, she was then correctly diagnosed as having multiple myeloma [ 24 ]. Another example of diagnostic errors and improper treatment is gastroenterological patients whose symptoms were of unclear etiology and were most commonly treated with antipsychotics [ 25 ].
One interesting study found in the Dutch General Practice Registry showed patients with a diagnosis of somatoform disorders had a higher infection load compared to matched controls preceding their diagnosis. The results of the study demonstrated a somatopsychic process. However, the authors concluded the opposite by stating the infection caused somatoform disorders, which instead would be viewed as psychological symptoms causing physical symptoms [ 26 ].
Other similar studies conclude a strong causal association between infections and psychiatric illness [ 27 , 28 ].
Difficult-to-diagnose cases are often viewed as invisible illnesses, since there may be no outward appearance of illness by a superficial examination.
They are tired of being unheard and told symptoms are imaginary, self-inflicted, and psychosomatic. As a result of this, they often describe feelings of abandonment from physicians and the healthcare system, which results in increased risks of suicidal ideation, suicide attempts, and suicide compared with the general population [ 29 ].
All guidelines have limitations and disclaimers that individualized judgment is necessary. Different guidelines have different levels of reliance upon randomized, controlled studies, which have two major limitations: 1 Once a certain level of knowledge is achieved by doing these studies, it is no longer ethical to continue further placebo-controlled studies.
Because of these and other limitations, guidelines are useful but cannot be universally applied [ 30 ]. Flawed guidelines have resulted from flawed research and bias. This problem is further compounded when well-intentioned physicians follow these guidelines assuming they are trustworthy.
Some patients stated that they felt belittled, dismissed, and ignored by their health care professionals who followed some of the commonly disseminated guidelines. Treatment recommendations based upon a graded activity and a cognitive behavioral therapy PACE trial were previously adopted by many healthcare organizations.
However, the research was highly flawed and never supported the belief that ignoring symptoms would lead to recovery [ 35 , 36 ]. The inaccurate treatment recommendations based upon the PACE trial recommended patients should ignore symptoms. In addition, patients were given a form of cognitive behavior therapy that challenged their beliefs of their having any physiological illness limiting their ability to exercise.
Instead, to become more active—and possibly fully recover—they only needed to ignore their symptoms [ 37 ]. After the PACE study was found to be invalid, there have been further advances in the field, and many guidelines have since been revised [ 39 ].
The IDSA Lyme disease guidelines have had multiple criticisms, including being highly biased and lacking objectivity, since the day they were published [ 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The IDSA is in the process of revising these guidelines in , and a draft of its guidelines was posted briefly for public comment. The revised guidelines showed little change in most of the areas of controversy, and attention to some of the flaws in the proposed guidelines has been addressed [ 50 , 51 , 52 ].
Two case presentations are given to demonstrate some of the relevant issues when differentiating between psychosomatic, somatopsychic, and multisystem illnesses, and they are discussed herein. To help make a differential diagnosis, relevant brain—body diagnostic terms used in making a differential diagnosis and terms in which there is confusion, controversy, debate, misdiagnoses, and abuse are then identified. Some of these are terms the first author has encountered while doing consultation-liaison psychiatry.
The terms are then defined and discussed. Some of these terms are identified and defined in formalized diagnostic references, which include the APA DSM-5 [ 54 ] and the International Classification of Diseases ICD , which are considered standards for diagnosis [ 54 , 55 ]. Other terms may be included in only one or neither of these references.
The terms that are defined include APA DSM-5 diagnostic categories, mental health, mental illness, psychosomatic disorders, somatopsychic disorders, multisystem disorders, medical uncertainty, somatoform disorders, medically unexplained symptoms, functional disorders, psychogenic disorders, compensation neurosis, psychogenic seizures, psychogenic pain, psychogenic fatigue, delusional parasitosis, subjective vs.
Articles relevant to defining and differentiating psychosomatic, somatopsychic, and multisystem illnesses are reviewed. Terms with the greatest potential for misuse and abuse are discussed in greater detail. Significant issues relevant to accurate diagnosis and diagnostic errors are discussed.
Conclusions are drawn to aid the clinician in differentiating psychosomatic, somatopsychic, multisystem illnesses, and medical uncertainty. Patient A is an year-old white female with multiple symptoms who had previously been healthy and adept at Taekwondo. She had seizure episodes. The patient was subsequently treated and is now physically active, married, and leading a productive life. Patient B lives in England and was diagnosed with reactive arthritis causing leg pain when she was 12 years old.
She then developed an excruciating headache accompanied by a complete loss of balance and involuntary jerking movements, which resulted in her mother bringing her to the hospital where she was admitted for one night. She was brought back to the hospital daily for several days as increasing and intensifying symptoms developed. Following this impression, no relevant investigations were performed. Patient B was left deteriorating and untreated, by which time she was having constant seizures and needed a wheelchair.
Her mother repeatedly told them that Lyme disease was highly suspected since the family lived in a region known to be epidemic for Lyme disease and other relatives had been diagnosed with the disease and begged them to help her daughter. These appeals were ignored. She was immediately put on intravenous antibiotics at the clinic for four days. In 36 hours, the seizures had stopped, and her headache slowly improved. Her blood tests came back positive for Lyme disease.
The hospital admitted their error and gave an unreserved apology. On instructions from the consultant, Patient B had a further three months of daily intravenous antibiotic treatment at a National Health Service Hospital. After about two months, Patient B was able to walk again, but when the antibiotics were stopped, the seizures and other symptoms returned.
The family raised funds to take Patient B to the United States for treatment by a physician who had experience with such cases. The treatment stabilized her condition and brought great improvement to some of her symptoms. However, due to the treatment delay, she still had some persistent health issues, including severe headaches, joint pains, extreme fatigue, cognitive dysfunction, and other symptoms.
In both cases, the complexity of a multisystem illness was not understood nor adequately pursued by the treating physicians. This led to tragic delays in diagnosis and treatment to both patients. The first author has seen and published descriptions of many other tragic cases in his practice [ 57 , 58 , 59 , 60 , 61 , 62 ]. When dealing with complex, inadequately investigated conditions in which many symptoms identified on a thorough history and review of systems are insufficiently or wholly unsupported by commonly used clinical laboratory tests, it is best to begin with definitions.
The symptoms expressed by these patients suggest a mind—body interplay; therefore, it is important to define terms that are most relevant to this, when making a diagnosis. These terms include mental health and mental illness, psychosomatic, somatopsychic, multisystem illness, medical uncertainty, and DSM-5, ICD, and other terms [ 54 , 55 ]. It expanded upon descriptions of psychiatric diagnostic categories and was the first official manual of mental disorders to focus on clinical use.
Since then, the two different diagnostic systems have evolved through different but sometimes related processes. The current International Classification of Disease is the 10th Revision; however, the proposed 11 th Revision will soon be implemented [ 55 ].
It is difficult to define mental illness unless mental health is first defined. A systems approach expands upon the biopsychosocial model used in psychiatry and helps to organize the multiple systems that contribute to human functioning in both health and disease [ 64 ].
For example, genomics, proteomics, etc. Mental illness is also called psychiatric illness and mental disorder. Mental illness is the result of an interaction of multiple contributors and susceptibilities resulting in a pathophysiological process. Using a systems model, mental functioning can be conceptualized as being a balance of multiple contributors and deterrents that result in either mental health or mental illness.
Mental illness is associated with an imbalance between these contributors and deterrents with a net effect that leads to a sequential pathological process.
That process may result in dysfunction that may cause mental symptoms and syndromes. Diagnostic and treatment delays can result in a perpetuation of disease progression and an increase in disease severity. Many of the mental disorders listed with different codes and defined in the APA DSM-5 can be conceptualized as dysregulated and excessive, aversive emotional states [ 67 ].
From this perspective, these dysregulated, aversive emotional states include environmental phobias agoraphobia, claustrophobia, acrophobia, etc. The DSM-5 only classifies symptoms and syndromes but does not address causality.
As a result, psychosomatic disorders are not identified, defined, or explained in the DSM-5 [ 54 ]. The ICD addresses causality with some diagnostic categories but does not address psychosomatic causality [ 55 ]. Since the APA DSM-5 does not address psychosomatic conditions and the ICD only partially addresses psychosomatic conditions, there are gaps in standardizing the definition and the classification of psychosomatic disorders.
Psychosomatic disorders are somatic illness caused or exacerbated by mental stress and distress. The list of conditions considered to have a purely psychosomatic basis keeps shrinking as scientific knowledge advances. Tuberculosis, hypertension, and stomach ulcers were all once considered as having a psychosomatic etiology.
However, it is recognized that many diseases have psychosomatic contributors and are made worse by stress and distress, such as heart disease, irritable bowel syndrome, nervous stomach, and skeletal muscle guarding [ 67 ]. When stress occurs in an individual who is more emotionally and physiologically reactive, there will be an increased allostatic load wear and tear on the body from stress with accompanying physiological changes.
These changes may include: 1 a shift in the autonomic nervous system balance from parasympathetic to sympathetic control; 2 changes in the hypothalamic-pituitary-adrenal axis; 3 increased blood pressure, heart rate, breathing; 4 increased blood glucose; 5 increased blood flow to skeletal muscles; 6 inflammation; 7 decreased regenerative recovery activity; 8 decreased digestive activity; and 9 decreased blood flow to the prefrontal cortex at higher levels of distress [ 68 , 69 , 70 ].
Although brief episodes of acute stress can generally be healthy and well tolerated in most, chronic unremitting stress in susceptible individuals can have a more deleterious effect. In an individual with genetic and other susceptibilities to stress, these changes may in turn result in psychosomatic symptoms and disorders. Individuals have different vulnerabilities that make them more prone to different psychosomatic conditions. One example of a psychosomatic illness is psychosomatic cardiovascular disease.
When this occurs in a susceptible individual, chronic stress activates the hypothalamic—pituitary—adrenal axis and the sympathetic branch of the autonomic nervous system, reduces vagal tone, increases plasma catecholamines, elevates heart rate, causes vasoconstriction, activates platelets, and reduces heart rate variability [ 71 ].
Associated chronic increases in proinflammatory cytokines contribute to endothelial damage, plaque formation, atherosclerotic thrombus formation, vascular occlusion, endothelial damage of the cerebral vasculature, and acute coronary syndromes. These autonomic and immune system changes singly and additively exert adverse effects, resulting in high cardiovascular morbidity and mortality [ 71 ].
Another example is irritable bowel syndrome. Dietary considerations, particularly gluten and lactose, also play a role in symptom exacerbation [ 72 , 73 ]. As a result, somatopsychic disorders are not defined and explained by formally used diagnostic systems, which leaves a gap in standardizing the definitions and the classification of somatopsychic disorders. Somatopsychic disorders are mental disorders caused or exacerbated by somatic disorders.
In contrast to psychosomatic disorders, the list of somatic conditions causing mental disorders keeps expanding as scientific knowledge advances. Many general medical conditions are recognized as causing psychiatric symptoms. Endocrine disorders, tumors, autoimmune disorders, and infections are particularly associated with causing psychiatric symptoms.
Thousands of peer-reviewed journal articles demonstrate the causal association between infections, somatic illness, and mental illness. Most of these symptoms are immune mediated. The identified infectious triggers include viral, venereal, and vector-borne diseases [ 74 , 75 ]. Multisystem disorders are conditions that impact the entire body and cause symptoms in multiple systems, such as the nervous system, the immune system, the endocrine system, etc. In these conditions, there are both somatic and psychiatric symptoms.
Sometimes, there is not a clear distinction between a somatopsychic and a multisystem disorder. The list of multisystem disorders associated with mental disorders keeps expanding, while the list of purely psychosomatic illnesses keeps shrinking as scientific knowledge advances. Multisystem disorders include deficiencies, toxic states, systemic infections, and systemic immune disorders. Schizophrenia, bipolar disorders, and other mental disorders are not exclusively neuropsychiatric disorders.
There is mounting evidence that these are multisystem disorders with immune-mediated metabolic components as well [ 76 , 77 , 78 , 79 ]. Medical uncertainty is not a diagnosis. Instead, there is always some degree of certainty or uncertainty with any medical condition or diagnosis.
There is still much to learn about illness and the brain—body interaction. No medical condition is totally explained or unexplained. Instead, knowledge is on a continuum, and all conditions are partially explained to different degrees [ 54 ]. As a result, some degree of uncertainty always has been, and always will be, a part of medicine. Diseases that are relatively easier to understand present with simpler and more clearly defined causes, pathophysiology, and symptoms.
The more challenging diseases are those that are more complex and are often considered more controversial. They have multiple disease contributors, pathophysiology, and symptom presentations with a greater amount of medical uncertainty. The many contributing factors to medical uncertainty include the uniqueness of individuals, biological heterogeneity, and the complexity of conditions. These result in variability of disease presentations and individual differences in treatment effectiveness, tolerability, and safety.
We also know there are known unknowns; that is to say we know there are some things we do not know. Medical uncertainty may result in patient and physician bias, error in test interpretation, differing values and opinions between patients and physicians, and uncertainty surrounding decision-making. There are several mental disorders that are particularly relevant to diagnostic controversies regarding the brain—body interface.
These conditions include somatic symptom disorders, somatoform disorders, functional neurological symptom disorder, illness anxiety disorder, factitious disorder, and factitious disorder imposed upon another. In addition, anxiety disorders, obsessive-compulsive disorders, trauma-related disorders, and stressor-related disorders are frequently associated with psychosomatic symptoms.
The one major distinction is the inclusion of bodily distress disorder in the proposed 11th Revision [ 55 ]. Somatic symptom disorders are included in the APA DSM-5 and are associated with excessive thoughts, feelings or behaviors related to somatic symptoms and one of three of the following criteria which need to be present for at least six months: 1 health anxiety, 2 disproportionate and persistent concerns about the medical seriousness of the symptoms, and 3 excessive time and energy devoted to symptoms or health concerns [ 54 ].
Somatic symptom disorders include somatic symptom disorder, Unlike somatoform disorders, the physical symptoms may or may not be associated with a diagnosed medical condition [ 54 ].
The basis of the diagnosis is instead dependent upon the extent to which the thoughts, feelings and behaviors related to the illness are excessive or out of proportion as subjectively determined by the evaluating physician [ 54 ].
Somatoform disorders were once considered to be a psychiatric condition marked by multiple, medically unexplained, physical, or somatic symptoms. They were physical symptoms for which a treating healthcare provider had found no medical cause or where the cause remained contested, unknown, or disputed. Most who used the term considered the symptoms had to be of a psychological origin.
It is now outdated and is not included as being relevant in the diagnosis of somatic symptom disorder in the APA DSM An explanation for eliminating this phrase is the recognition that no medical condition is totally explained or unexplained; instead, knowledge is on a continuum, and all conditions are partially explained to different degrees. These symptoms are often unexamined rather than unexplained [ 54 ]. It was previously called conversion disorder.
An example would be the paralysis of an arm after striking a family member during an argument. The psychodynamic explanation is unconscious repression of intrapsychic conflicts resulting in a conversion into a physiological symptom, such as hysterical blindness or paralysis.
Although the diagnosis of conversion disorder is given freely by some physicians, actual cases are only rarely seen in developed countries [ 83 ]. An example would be a fear of acquiring acquired immunodeficiency syndrome AIDS from using a public swimming pool. This contrasts with somatic symptom disorder in which there is an excessive concern regarding symptoms that currently exist.
Cyberchondria is not an APA DSM diagnosis but may be a category of illness anxiety disorder that occurs when there is excessive illness anxiety associated with using the Internet for healthcare information [ 84 ].
The Internet has made medical information more available to the public, and individuals with limited medical knowledge sometimes have difficulty interpreting medical information in the proper context. Illness anxiety disorder can sometimes be confused with normal health concerns. For example, a person injects a foreign substance into themselves to contrive an illness that would not otherwise exist. For example, a parent injects a foreign substance into their child to contrive an illness that would not otherwise exist.
True cases of factitious disorder and factitious disorder imposed on another are extremely rare. The DSM-5 criteria require contrived deception, not disagreement about the diagnosis or the seriousness of the symptoms [ 54 ]. Factitious disorder imposed on another is a highly controversial diagnosis.
Most allegations involve a single parent—but sometimes both parents—and it may involve one or more children. In these cases, disagreement between a parent or parents and the treating pediatrician sometimes result in an improper diagnosis of factitious disorder imposed on another. False allegations of factitious disorder imposed on another usually involve a child with an orphan disease or a complex disease not adequately understood by the physician giving the diagnosis.
The charges against these parents accuse them of believing their children are sick because of their own psychopathology [ 85 ]. In some countries such as the Netherlands, children with chronic or complex illnesses such as Lyme disease are sometimes removed from their parents by Child Protection Services.
Out of concern for the increase in false accusations of Munchausen By Proxy, an advocacy group for chronically ill children has documented over such cases in the Netherlands.
In around one-third of these cases, the child had Lyme disease. These cases have been recorded as human rights violations by the United Nations [ 86 ]. Factitious disorder upon another is a contrived illness. It is not a disagreement about a diagnosis or the seriousness of an illness. It is possible to contrive a tumor by injecting a foreign substance, but it is difficult to imagine how anyone could contrive the multiple symptoms associated with Lyme disease or other complex multisystem illnesses.
Functional disorders have never been included in any edition of the American Psychiatric Association Diagnostic and Statistical Manual. However, functional intestinal disorder, unspecified, K A functional disorder is viewed as a medical condition that impairs normal functioning of bodily processes and remains largely undetected under physical examination, dissection, or by microscopic examination.
To meet the definition, there must be no exterior appearance of abnormality. A functional disorder contrasts with a structural disorder in which some part of the body is seen as being abnormal. An inadequate assessment can result in an inaccurate diagnosis of a functional disorder. Psychogenic disorders were never included in any edition of the American Psychiatric Association Diagnostic and Statistical Manual. However, the term is included in ICD as other somatoform disorders, F Third, five clinical doctors and senior medical graduates inspected and evaluated the readability of the questionnaire and the appropriateness of its scientific content.
The final items were randomly distributed throughout the questionnaire to form the first version of the somatic symptoms checklist.
The first version of the somatic symptoms checklist was used to survey the second sample group. Survey data were analyzed using principal component analysis. The result of the first Principle Components Analysis, 16 items were deleted because they did not significantly correlate with the total score, and the square of the multiple correlations was less than 0. The remaining 89 items were arranged to form the second version of the questionnaire , which was used to survey the third sample group.
An EFA was performed on the data from patients who completed the second version, from which the structure of the preliminary clinical somatic symptoms was established. CFA was performed on the data for the remaining patients in the third sample group, which established a reasonable assessment of the structure of the clinical somatic symptoms. Data were processed and statistically analyzed using SPSS This study analyzed the structure of clinical somatic symptoms using EFA [ 15 ].
The second principal component analysis included 18 factors. All of the indices were in accordance with the standard assessment of the appropriateness of factor analysis. The Kaiser Meyer Olkin test value was 0. This result indicated that there was a common factor in the overall correlation matrix, further indicating the suitability for factor analysis.
According to Principal Component Analysis and the structure of the scree plot, four significant factors were extracted eigenvalues greater than 1 , and the maximum variance orthogonal rotation load value was greater than 0. Content validity plays an important role in clinical evaluation [ 16 ]. The content validity of the clinical somatic symptoms classification model in this study could largely be evaluated through previous research such as clinical research, theory formulation, and professional judgment ; the questionnaire showed good content validity.
EFA and CFA were used to validate the model during the process of developing and testing the instrument derived from theory [ 17 ]. The inclusion and exclusion standards were the same as those in study 1. CFA fit indices for the total clinical somatic symptoms scale Table 2.
Table 2 shows that the various indices showed a good fit between the measured data and the assumed model [ 18 ]. Diagram of the internal structure variance model of clinical somatic symptoms Fig 1. Fig 1 shows the somatic symptom internal structure model. The factor analysis verified our hypothesis for clinical somatic symptom classification and showed that the questionnaire had fairly good content validity and construct validity. The clinical symptoms assessment result 2 second result regarding the clinical somatic symptoms scale was assessed according to the clinical somatic symptoms scale.
The calculated kappa value of result 1 and result 2 was 0. The results showed that the scale has good test validity.
The kappa statistic [ 19 ] was employed to evaluate concordance between the two methods. This study was based on a summary of clinical experience and an analysis of the factor structure of the classification of symptoms. Somatic symptoms include emotional, biological, imaginative, and cognitive symptoms. Somatic symptoms can manifest themselves as changes in mood, especially as the direct expression of negative emotions resulting from the perception of somatic symptoms.
In such cases, the somatic symptoms cause the emotions themselves. For example, in some people with somatic symptoms, the symptoms may replace their emotions when they do not experience acceptance by others or by themselves or when they avoid contact [ 20 ]. The alexithymia theory [ 21 ] postulates that patients with alexithymia exaggerate the normal feeling in a body part and distort the arousal of somatic symptoms.
The patient may often express emotional distress through somatic symptoms. In medical patients, emotional distress may also result from the treatment of their somatic symptoms. Thus, depressed patients may present with somatic symptoms rather than emotional problems [ 22 ].
Biological somatic symptoms are closely related to the pathological changes in the organ or system of organs. For instance, hysterical blindness may involve an important regulation mechanism relevant to this topic.
Other researchers believe that psychological features are useful for classifying patients with somatic symptoms [ 24 ]. The cognitive theory postulates that the body reflects the central nervous system symptoms in peripheral tissues and organs; this concept is necessary for understanding relevant information and somatization related to information processing, such as the understanding of pain. Pain can be verified objectively, and interpretation of nervous system aberrations reveals individual differences.
If the feeling of objective existence is interpreted as a negative emotion, this phenomenon can lead to the formation of somatic symptoms. Such individuals show personality traits and an innate genetic susceptibility that lead them to misconstrue signals in the body as physical sensations related to a serious physical illness.
It is thought that the above problem results from the lack of cognitive resources to understand bodily symptoms, in which too much focus is placed on the bodily symptoms.
However, it is difficult to allocate cognitive resources to attend to the accompanying symptoms and the emotional stress of life events, other aspects of an information-based society, and stressful situations. Thus, the process leads to activation of a symptom and the inappropriate attribution cycle of the somatization of symptoms [ 6 ]. The classification of somatic symptoms described above can be applied as follows: 1 to develop clinical thinking and improve understanding of physical symptoms to better implement the unified psychosomatic point of view; 2 to help establish guidelines for the diagnosis of somatic symptoms and mental illness; and 3 to help establish guidelines for the treatment of somatic symptoms, such as the management of weak symptoms with antidepressant treatments and irritable emotional symptoms with anti-anxiety drugs.
Cognitive symptoms can be alleviated with cognitive-behavioral therapy, and biological symptoms can be alleviated by means of local and systemic physical treatment.
It is worth noting that the methods intended to increase understanding of bodily symptoms from additional perspectives should vary from patient to patient and implement a diverse mode of thinking. Nevertheless, the unified psychosomatic point of view and diverse clinical thinking modes are aimed at identifying somatic symptoms and are important prerequisites for the treatment of these symptoms. This paper developed a classification theory of clinical somatic symptoms from the perspective of psychosomatic medicine, which includes emotional, biological, imaginative, and cognitive somatic symptoms.
Moreover, the theoretical model for this theory was supported by empirical research. The clinical somatic symptom classification scale showed good reliability, content validity and construct validity and can thus be applied as an evaluation tool.
Based on the interpretation of the clinical symptom of psychosomatic medicine, in the treatment of chronic non-infectious diseases including at least three dimensions: the first is the etiological treatment, the second is the pathophysiological and pathopsychological dimension, and the third is symptomatic treatment. It shall be noticing that somatic symptoms need more attention.
Psychosomatic unity and a diverse mode of clinical thinking are important to understand somatic symptoms and the treatment of somatic symptoms. Conceptualization: XS. Data curation: FZ. Formal analysis: FZ. Methodology: FZ XS. Software: FZ. Writing - original draft: FZ. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Objective This article adopts the perspective of psychosomatic medicine to present and test a theoretical model of the classification of clinical somatic symptoms.
Method A clinical somatic symptom classification scale was developed according to the theoretical model. Results The results confirmed the theoretical model. Conclusions Based on the interpretation of the clinical symptoms of psychosomatic medicine, the treatment of chronic non-infectious diseases includes at least three dimensions: the first is the etiological treatment, the second is the pathophysiological and pathopsychological dimension, and the third is symptomatic treatment.
Funding: The authors received no specific funding for this work. Introduction Form this point of view clinical disciplines must address the various somatic symptoms of patients during consultation. Materials and Methods Theoretical model of the classification of clinical somatic symptoms within the framework of psychosomatic medicine Clinical classification and diagnosis are intended to target treatment and to generate accurate ideas for clinical diagnosis and treatment.
Biological somatic symptoms These are mainly produced by physical, chemical, and biological factors that are a direct result of partial damage to nerve endings or the result of local tissue injury after biochemical reactions caused by the suboptimal stimulation of nerve endings.
Emotional somatic symptoms In this case, the somatic experience is rooted in negative emotional symptoms. Imaginative somatic symptoms This category refers to patient symptoms that result from imagination, suggestion, or autosuggestion. Cognitive somatic symptoms The word cognitive here has two meanings. A study of the clinical somatic symptoms scale Objective. An empirical study was conducted to validate the proposed theoretical model.
Results EFA of the classification structure of clinical somatic symptoms This study analyzed the structure of clinical somatic symptoms using EFA [ 15 ]. Validity testing of the structure of the clinical somatic symptoms classification assessment Content validity.
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