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.

A study was carried out with 501 persons to analyze the predictive capacity of various psychosocial variables—symptom perception, neuroticism, Personality Types 2 and 4 of Grossarth-Maticek and Eysenck, beliefs about health, social support, or certain coping styles—on two health-related behaviors: the frequency of visits to the doctor and self-medication. The results were analyzed by two structural equation models that revealed that some of the variables have direct effects on the behaviors, whereas other variables, such as attribution style, coping styles, or the impact of the stressors, have indirect effects via the reported symptoms or neuroticism. In addition, self-medication and the frequency of health service visits are independent of each other, which shows that their determinants are different. It is concluded that to address these factors in the two health indicators, it is also necessary to take in account the psychosocial variables considered herein.