Physical symptom disorder: A simpler diagnostic category for somatization-spectrum conditions

Objective: To propose a simpler, more empiric, and patient-centered category for classifying physical symptoms that is "etiologically neutral," that is, not reliant on the assumption that symptoms that are poorly explained from a medical standpoint must de facto be psychological in origin. Methods: Theoretical analysis, narrative review, and proposal. Results: Studies have revealed several limitations in the current classification of somatoform disorders, including the poor reliability of lifetime symptom recall, the difficulty in adjudicating physical versus psychological explanations, and the stigma in assigning patients with medically unexplained symptoms to an Axis I psychiatric disorder. Physical symptom disorder (PSD) is proposed as a diagnostic category that would reside on Axis III (rather than Axis 1) and replace somatization disorder, undifferentiated somatoform disorder, and pain disorder. PSD would consist of one or more physical symptoms currently present, not fully explainable by another medical or psychiatric disorder (with the exception of functional somatic syndromes), causing functional impairment. Duration must be at least 6 months, and severity could be graded as mild, moderate, or severe using a 15-symptom checklist (PHQ-15). Finally, the type of symptoms or symptom syndromes present in the patient could be specified. Conclusions: PSD should be considered as a simpler and more inclusive diagnosis to replace several somatoform diagnoses currently in use. (c) 2006 Elsevier Inc. All rights reserved.