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Empirical foundations for the diagnosis of somatization: implications for DSM-5

Published online by Cambridge University Press:  16 September 2010

J. G. M. Rosmalen ,
L. M. Tak  and
P. de Jonge
J. G. M. Rosmalen*
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
L. M. Tak
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
P. de Jonge
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
*
*Address for correspondence: Dr J. G. M. Rosmalen, Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. (Email: j.g.m.rosmalen@med.umcg.nl)
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Abstract

Background

The aim of this study was to develop empirically validated criteria for the diagnoses of clinically relevant somatization.

Method

This study was performed in a population-representative cohort consisting of 461 males (47.8%) and 503 females (52.2%), with an average age of 55.8 years (s.d.=11.1). Somatization, anxiety and depression were derived from the Composite International Diagnostic Interview. Mplus was used to perform confirmative factor analyses on the current DSM-IV symptom groups; on alternative symptom clusters previously suggested; and to perform latent class analysis in order to define an empirically derived cut-off for somatization.

Results

The existence of symptom groups as described in DSM-IV was not supported by our data, whereas a differentiation between cardiopulmonary, musculoskeletal, gastrointestinal and general somatic symptoms did fit our data. Latent class analysis revealed two classes characterized by few (n=859) and many (n=105) symptoms. The class of subjects could be approached by a simple cut-off of four functional symptoms (sensitivity 79%, specificity 98%, positive predictive value 82%, negative predictive value 97%) regardless of the number of organ systems involved.

Conclusions

This study in a large population-representative cohort suggests that a simple symptom count can be used as a dimensional diagnosis of somatization. In those instances in which a categorical diagnosis is preferred, a simple cut-off of four out of 43 functional symptoms best fitted our data. We did not find any added value for incorporating the number of symptom clusters into the diagnostic criteria.

Keywords

DiagnosisDSMpopulation cohortsomatization
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1133 - 1142
Copyright
Copyright © Cambridge University Press 2010

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