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Am J Psychiatry 1991; 148:34-40
Copyright © 1991 by American Psychiatric Association
Somatization: a spectrum of severity
W Katon, E Lin, M Von Korff, J Russo, P Lipscomb and T Bush
Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle 98195.
OBJECTIVE: The DSM-III-R diagnosis of somatization disorder requires that a
patient have a specific number of medically unexplained somatic symptoms.
This number of symptoms was developed by committee consensus, and it is not
clear whether patients with this specific number of symptoms can be
differentiated from patients with lower but still substantial numbers of
somatic symptoms. METHOD: Fifty-one percent of 767 high utilizers of two
primary care clinics were identified as distressed by an elevated SCL
anxiety, depression, or somatization scale score or by their primary care
physician. The Diagnostic Interview Schedule (DIS) was completed on 119
distressed high utilizers who were randomly assigned to an intervention
group in a controlled trial of psychiatric consultation. The 119 distressed
high utilizers were separated into four categories according to the number
of unexplained somatic symptoms found on the DIS and were compared on
demographic, psychiatric distress, disability, medical, and health
utilization variables. RESULTS: The data suggest that many clinical and
behavioral features of somatization are significantly more common in
patients with four to 12 medically unexplained somatic symptoms rather than
changing dramatically at the diagnostic threshold for somatization
disorder. The data also showed that patients who meet the DSM-III-R
criteria for somatization disorder are severely ill and have a high burden
of psychiatric illness and disability. CONCLUSIONS: The results suggest
that the DSM-IV somatoform disorders section should include somatization
disorder, an abridged definition of somatization disorder often associated
with anxiety and depression, as well as a type of somatization associated
with an adjustment disorder.
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