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The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model

Published online by Cambridge University Press:  28 December 2015

Fiammetta Cosci  and
Giovanni A. Fava
Fiammetta Cosci*
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
Giovanni A. Fava
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
*
*Address for correspondence: Fiammetta Cosci, Department of Health Sciences, Unit of Psychology and Psychiatry, via di San Salvi, 12 50135 Florence, Italy. (Email: [email protected])
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Abstract

The Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term “somatic symptoms” reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research.

Keywords

ClinimetricDiagnostic Criteria for Psychosomatic ResearchDSM-5illness behaviorsomatic symptom
Type
Review Articles
Information
CNS Spectrums , Volume 21 , Special Issue 4: Nosology in DSM5 vs. ICD , August 2016 , pp. 310 - 317
Copyright
© Cambridge University Press 2015 

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References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
2. Sirri, L, Fava, GA. Diagnostic criteria for psychosomatic research and somatic symptom disorders. Int Rev Psychiatry. 2013; 25(1): 19–30.CrossRefGoogle ScholarPubMed
3. van den Heuvel, OA, Veale, D, Stein, DJ. Hypochondriasis: considerations for ICD-11. Rev Bras Psiquiatr. 2014; 36(Suppl 1): 21–27.Google Scholar
4. Calkins, AW, Berman, NC, Wilhelm, S. Recent advances in research on cognition and emotion in OCD: a review. Curr Psychiatry Rep. 2013; 15(5): 357.CrossRefGoogle Scholar
5. Veale, D, Gournay, K, Dryden, W, et al. Body dysmorphic disorder: a cognitive behavioural model and a pilot randomised controlled trial. Behav Res Ther. 1996; 34(9): 717–729.Google Scholar
6. Cosci, F, Fava, GA. Staging of mental disorders: systematic review. Psychother Psychosom. 2013; 82(1): 20–34.Google Scholar
7. Stone, J, Carson, A, Duncan, R, et al. Symptoms “unexplained by organic disease” in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain. 2009; 132(Pt 10): 2878–2888.CrossRefGoogle ScholarPubMed
8. Cosci, F, Fava, GA, Sonino, N. Mood and anxiety disorders as early manifestations of medical illness: a systematic review. Psychother Psychosom. 2015; 84(1): 22–29.CrossRefGoogle ScholarPubMed
9. Sirri, L, Fava, GA. Clinical manifestations of hypochondriasis and related conditions. In: Starcevic V, Noyes R, eds. Hypochondriasis and Health Anxiety. A Guide for Clinicians. Oxford, UK: Oxford University Press; 2014: 8–27.Google Scholar
10. Lipowski, ZJ. Somatization: the experience and communication of psychological distress as somatic symptoms. Psychother Psychosom. 1987; 47(3–4): 160–167.CrossRefGoogle ScholarPubMed
11. Härter, M, Baumeister, H, Reuter, K, et al. Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychother Psychosom. 2007; 76(6): 354–360.CrossRefGoogle ScholarPubMed
12. Engel, GL. Psychological aspects of gastrointestinal disorders. In: Reiser MF, ed. American Handbook of Psychiatry. New York: Basic Books; 1975: 653–692.Google Scholar
13. Fava, GA, Sonino, N. The clinical domains of psychosomatic medicine. J Clin Psychiatry. 2005; 66(7): 849–858.Google Scholar
14. Ly, HG, Ceccarini, J, Weltens, N, et al. Increased cerebral cannabinoid-1 receptor availability is a stable feature of functional dyspepsia: a [F]MK-9470 PET study. Psychother Psychosom. 2015; 84(3): 149–158.Google Scholar
15. Pilowsky, I. Abnormal Illness Behaviour. Chichester, England: Wiley; 1997.Google Scholar
16. Mechanic, D, Volkart, EH. Illness behavior and medical diagnoses. J Health Hum Behav. 1960; 1(2): 86–94.CrossRefGoogle Scholar
17. Mechanic, D. Sociological dimensions of illness behavior. Soc Sci Med. 1995; 41(9): 1207–1216.Google Scholar
18. Sirri, L, Fava, GA, Sonino, N. The unifying concept of illness behavior. Psychother Psychosom. 2013; 82(2): 74–81.Google Scholar
19. Fava, GA, Kellner, R, Zielezny, M, et al. Hypochondriacal fears and beliefs in agoraphobia. J Affect Disord. 1988; 14(3): 239–244.Google Scholar
20. Fava, GA, Porcelli, P, Rafanelli, C, et al. The spectrum of anxiety disorders in the medically ill. J Clin Psychiatry. 2010; 71(7): 910–914.CrossRefGoogle ScholarPubMed
21. Sonino, N, Sirri, L, Fava, GA. Including illness behavior in the assessment of endocrine patients. J Clin Endocrinol Metab. 2014; 99(9): 3122–3124.CrossRefGoogle ScholarPubMed
22. Fava, GA, Freyberger, HJ, Bech, P, et al. Diagnostic criteria for use in psychosomatic research. Psychother Psychosom. 1995; 63(1): 1–8.Google Scholar
23. Hanel, G, Henningsen, P, Herzog, W, et al. Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009; 67(3): 189–197.Google Scholar
24. Leiknes, KA, Finset, A, Moum, T, et al. Overlap, comorbidity, and stability of somatoform disorders and the use of current versus lifetime criteria. Psychosomatics. 2008; 49(2): 152–162.Google Scholar
25. Porcelli, P, Guidi, J. The clinical utility of the Diagnostic Criteria for Psychosomatic Research (DCPR): a review of studies. Psychother Psychosom. 2015; 84(5): 265–272.CrossRefGoogle ScholarPubMed
26. Porcelli, P, Sonino, N. Psychological Factors Affecting Medical Conditions. A New Classification for DSM-V. Advances in Psychosomatic Medicine. Basel, Switzerland: Karger; 2007.CrossRefGoogle Scholar
27. Tomba, E, Rafanelli, C, Grandi, S, et al. Clinical configuration of cyclothymic disturbances. J Affect Disord. 2012; 139(3): 244–249.CrossRefGoogle ScholarPubMed
28. Galeazzi, GM, Ferrari, S, Mackinnon, A, et al. Interrater reliability, prevalence, and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic Research in consultation-liaison psychiatry patients. Psychosomatics. 2004; 45(5): 386–393.Google Scholar
29. Fava, GA, Guidi, J, Porcelli, P, et al. A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill. Psychol Med. 2012e; 42(2): 401–407.Google Scholar
30. Feinstein, AR. Clinimetrics. New Haven, CT: Yale University Press; 1987.CrossRefGoogle Scholar
31. Fava, GA, Tomba, E, Sonino, N. Clinimetrics: the science of clinical measurements. Int J Clin Pract. 2012; 66(1): 11–15.Google Scholar
32. Fava, GA, Sonino, N, Wise, TN. The Psychosomatic Assessment. Strategies to Improve Clinical Practice. Advances in Psychosomatic Medicine. Basel, Switzerland: Karger; 2012.Google Scholar
33. Feinstein, AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970; 23(7): 455–468.Google Scholar
34. Feinstein, AR. An analysis of diagnostic reasoning. I. The domains and disorders of clinical microbiology. Yale J Biol Med. 1973; 46(3): 212–232.Google Scholar
35. Avia, MD, Ruiz, MA, Olivares, ME, et al. The meaning of psychological symptoms. Behav Res Ther. 1996; 34(1): 23–31.Google Scholar
36. Warwick, HM, Clark, DM, Cobb, AM, et al. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry. 1996; 169(2): 189–195.CrossRefGoogle ScholarPubMed
37. Bouman, TK, Visser, S. Cognitive and behavioural treatment of hypochondriasis. Psychother Psychosom. 1998; 67(4–5): 214–221.Google Scholar
38. Clark, DM, Salkovskis, PM, Hackmann, A, et al. Two psychological treatments for hypochondriasis. Br J Psychiatry. 1998; 173(3): 218–225.CrossRefGoogle ScholarPubMed
39. Fava, GA, Grandi, S, Rafanelli, C, et al. Explanatory therapy of hypochondriasis. J Clin Psychiatry. 2000; 61(4): 317–322.Google Scholar
40. Barsky, AJ, Ahern, DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. 2004; 291(12): 1464–1470.CrossRefGoogle ScholarPubMed
41. Nakao, M, Shinozaki, Y, Ahern, DK, et al. Anxiety as a predictor of improvements in somatic symptoms and health anxiety associated with cognitive-behavioral intervention in hypochondriasis. Psychother Psychosom. 2011; 80(3): 151–158.Google Scholar
42. Tyrer, P, Salkovskis, P, Tyrer, H, et al. Cognitive behaviour therapy for health anxiety. Lancet. 2014; 383(9925): 1295–1296.Google Scholar
43. Porcelli, P, Bellomo, A, Quartesan, R, et al. Psychosocial functioning in consultation-liaison psychiatry patients: influence of psychosomatic syndromes, psychopathology and somatization. Psychother. Psychosom. 2009; 78(6): 352–358.Google Scholar
44. Fava, GA, Grandi, S. Differential diagnosis of hypochondriacal fears and beliefs. Psychother Psychosom. 1991; 55(2–4): 114–119.Google Scholar
45. Noyes, R, Carney, CP, Langbehn, DR. Specific phobia of illness: search for a new subtype. J Anxiety Disord. 2004; 18(4): 531–545.Google Scholar
46. Sonino, N, Navarrini, C, Ruini, C, et al. Persistent psychological distress in patients treated for endocrine disease. Psychother Psychosom. 2004; 73(2): 78–83.Google Scholar
47. Porcelli, P, De Carne, M, Fava, GA. Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychother Psychosom. 2000; 69(4): 198–204.CrossRefGoogle ScholarPubMed
48. Engel, GL. Conversion symptoms. In: MacBryde CM, Blacklow RS, eds. Signs and Symptoms, Applied Pathological Physiology and Clinical Interpretation. Philadelphia: Lippincott; 1970: 650–668.Google Scholar
49. Porcelli, P, Fava, GA, Rafanelli, C, et al. Anniversary reactions in medical patients. J Nerv Ment Dis. 2012; 200(7): 603–606.Google Scholar
50. Goldbeck, R. Denial in physical illness. J Psychosom Res. 1997; 43(6): 575–593.Google Scholar
51. Grassi, L, Sabato, S, Rossi, E, et al. Use of the diagnostic criteria for psychosomatic research in oncology. Psychother Psychosom. 2005; 74(2): 100–107.Google Scholar
52. Grandi, S, Sirri, L, Tossani, E, et al. Psychological characterization of demoralization in the setting of heart transplantation. J Clin Psychiatry. 2011; 72(5): 648–654.CrossRefGoogle ScholarPubMed
53. Fava, GA, Guidi, J, Semprini, F, Tomba, E, Sonino, N. Clinical assessment of allostatic load and clinimetric criteria. Psychother Psychosom. 2010; 79(5): 280–284.Google Scholar
54. Frank, JD. Persuasion and Healing. Baltimore, MD: Johns Hopkins University Press; 1961.Google Scholar
55. Schmale, AH, Engel, GL. The giving up-given up complex illustrated on film. Arch Gen Psychiatry. 1967; 17(2): 133–145.Google Scholar
56. Tecuta, L, Tomba, E, Grandi, S, et al. Demoralization: a systematic review on its clinical characterization. Psychol Med. 2015; 45(4): 673–691.Google Scholar
57. Snaith, RP, Taylor, CM. Irritability: definition, assessment and associated factors. Br J Psychiatry. 1985; 147(2): 127–136.Google Scholar
58. Rafanelli, C, Sirri, L, Grandi, S, et al. Is depression the wrong treatment target for improving outcome in coronary artery disease? Psychother Psychosom. 2013; 82(5): 285–291.Google Scholar
59. Friedman, M, Rosenman, RH. Type A Behavior and Your Heart. New York: Knopf; 1974.Google Scholar
60. Sirri, L, Fava, GA, Guidi, J, et al. Type A behaviour: a reappraisal of its characteristics in cardiovascular disease. Int J Clin Pract. 2012; 66(9): 854–861.Google Scholar
61. Sifneos, PE. The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom. 1973; 22(2): 255–262.Google Scholar
62. Taylor, GJ. Affects, trauma, and mechanisms of symptom formation: a tribute to John C. Nemiah, MD (1918–2009). Psychother Psychosom. 2010; 79(6): 339–349.Google Scholar
63. De Vries, AM, Forni, V, Voellinger, R, et al. Alexithymia in cancer patients: review of the literature. Psychother Psychosom. 2012; 81(2): 79–86.Google Scholar
64. Lumley, MA, Neely, LC, Burger, AJ. The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess. 2007; 89(3): 230–246.CrossRefGoogle ScholarPubMed
65. Porcelli, P, Bagby, RM, Taylor, GJ, et al. Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders. Psychosom Med. 2003; 65(5): 911–918.Google Scholar
66. Honkalampi, K, Lehto, SM, Koivumaa-Honkanen, H, et al. Alexithymia and tissue inflammation. Psychother Psychosom. 2011; 80(6): 359–364.Google Scholar
67. Cosci, F. Assessment of personality in psychosomatic medicine: current concepts. Adv Psychosom Med. 2012; 32: 133–159.Google Scholar
68. Guidi, J, Rafanelli, C, Roncuzzi, R, et al. Assessing psychological factors affecting medical conditions: comparison between different proposals. Gen Hosp Psychiatry. 2013; 35(2): 141–146.Google Scholar
69. Engel, GL. A unified concept of health and disease. Perspect Biol Med. 1960; 3: 459–485.Google Scholar
70. Evers, AW, Gieler, U, Hasenbring, MI, van Middendorp, H. Incorporating biopsychosocial characteristics into personalized healthcare. Psychother Psychosom. 2014; 83(3): 148–157.Google Scholar
71. Fava, GA, Guidi, J, Rafanelli, C, Sonino, N. The clinical inadequacy of evidence-based medicine and the need for a conceptual framework based on clinical judgment. Psychother Psychosom. 2015; 84(1): 1–3.Google Scholar