In principal, MUS and MES resulted in comparable impairment and stability. Due to conceptual and methodological difficulties, classification criteria for somatoform disorders should not be restricted to somatic aspects of the symptomatology.

When revising the former somatoform diagnoses to somatic symptom disorders, DSM-5 introduced psychological classification criteria in addition to somatic symptoms. The authors investigated the relevance of these and further cognitive, affective, and behavioral features as well as their predictive value concerning (a) somatic symptoms that are not better explained by a general medical condition (MUS) and somatoform disorders (SD), (b) impairment, and (c) health care utilization. A general population sample of 321 participants (M = 47.0 years, 63% women) was interviewed at baseline and reinterviewed 1 year (N = 244) and 4 years (N = 219) later. The authors assessed a list of 49 somatic complaints including medical causes, the symptom-related subjective impairment, doctor visits during the previous 12 months, depressive/anxiety disorders (SCID), and 9 psychological features with potential use for classification. Most psychological features were more frequent in subjects with SD compared to nonsufferers. Reassurance seeking, body checking, a self-concept of bodily weakness, catastrophizing of physical sensations, avoidance of physical activities, and negative affectivity incrementally predicted medium- and long-term standard deviation: The odds ranged from 2.4 to 9.8 (95% confidence intevals: [1.1, 5.0], [1.7-57.9]), with up to 90% correct predictions for the overall model. Lower somatic symptom attribution and higher health anxiety were incremental predictors of the number of MUS after 4 years. Long-term impairment and health care use were not incrementally predicted by psychological features. To conclude, psychological criteria showed relevance and predictive value for the classification of somatoform symptoms. Therefore, the inclusion seems warranted, although the DSM-5 selection of psychological features needs further investigation.

FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.

The PHQ-15, WI-7, and SAIB are useful screening instruments to detect persons at risk for somatic symptom disorder, and a combination of these three instruments slightly improves diagnostic accuracy. Their use in routine care will lead to improved detection rates.