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Medium- and long-term prognostic validity of competing classification proposals for the former somatoform disorders

Published online by Cambridge University Press:  09 February 2017

S. Schumacher ,
W. Rief ,
K. Klaus ,
E. Brähler  and
R. Mewes
S. Schumacher*
Affiliation:
Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
W. Rief
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
K. Klaus
Affiliation:
Department of Clinical Biopsychology, University of Marburg, Marburg, Germany
E. Brähler
Affiliation:
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center, Mainz, Germany
R. Mewes
Affiliation:
Department of Clinical Biopsychology, University of Marburg, Marburg, Germany
*
*Address for correspondence: S. Schumacher, Ph.D., Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. (Email: sarah.schumacher@fu-berlin.de)
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Abstract

Background

DSM-5 introduced a fundamental revision of the category of somatoform disorders, which resulted in the new somatic symptom disorder (SSD) and related disorders. However, prognostic validity of SSD remains unclear, while other classification proposals, such as bodily distress disorder (BDD) or polysymptomatic distress disorder (PSDD), might be promising alternatives for the new ICD-11. Therefore, the comparison of the different approaches concerning long-term prognosis of disorder-relevant factors is of special interest.

Method

In a longitudinal design (baseline, 1-year, and 4-year follow-up), the three proposals (SSD, BDD, PSDD) were compared in an age-representative sample of the German general population (N = 321). To this end, the baseline sample was divided into three independent pairs of groups (with/without SSD, with/without BDD, with/without PSDD). It was tested how well each approach differentiated with regard to medium- and long-term healthcare utilization, number of symptoms, and impairment.

Results

Criteria for BDD distinguished best with regard to future healthcare utilization resulting in a large-sized effect (f = 0.44) for the difference between persons with and without BDD, while SSD and PSDD revealed only medium-sized effects (f = 0.28 and f = 0.32) between subjects with and without diagnosis. The three proposals distinguished equally well with regard to future subjective impairment (between f = 0.39 and f = 0.41) and the number of reported symptoms (between f = 0.77 and f = 0.83).

Conclusion

In accordance with our data regarding prognostic validity, the current draft of the WHO group is based on the BDD proposal. However, existing limitations and weaknesses of the present proposal for the ICD-11 are further discussed.

Keywords

Classification criteriaICD-11prognostic validitysomatoform disorders
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 10 , July 2017 , pp. 1719 - 1732
Copyright
Copyright © Cambridge University Press 2017 

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