The Concept of Psychosomatic Disorder

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9–95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview. Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was ‘somatoform disorders not otherwise specified’, followed by bulimia nervosa, ‘depressive disorder not otherwise specified’, anorexia nervosa, conversion disorder, major depression or depressive disorder, ‘panic disorder with agoraphobia‘, and ‘psychological factors affecting physical or medical condition’. On axis II, 11–17% of the patients met the criteria for personality disorder. On axis IV, 78–80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Assessment of Patients by DSM-III-R and DSM-IV in a Japanese Psychosomatic Clinic

Nakao

Nomura

Yamanaka

et al. 1998

“…For instance, in a naive conceptualization, yet the one implicitly endorsed by DSM-III and DSM-IV, well-being and distress may be seen as mutually exclusive (i.e., well-being is a lack of distress). Yet, there is evidence to call such views in question [19, 20, 21, 22, 23, 24]. In drug trials, subscales describing well-being were more sensitive or as sensitive to drug effects as subscales describing symptoms [16].…”

Section: Methodological Issuesmentioning

confidence: 99%

Subclinical Symptoms of Panic Disorder: New Insights into Pathophysiology and Treatment

Fava

Mangelli²

1999

Self Cite

The aim of this review was to survey the available literature on prodromal and residual symptoms of panic disorder. Both a computerized (Medline) and a manual search of the literature were performed. In a substantial proportion of patients with panic disorder with agoraphobia a prodromal phase can be identified. Most patients report residual symptoms despite successful treatment. Residual symptoms upon remission have a prognostic value. There appears to be a relationship between residual and prodromal symptomatology (the rollback phenomenon). Appraisal of subclinical symptomatology in panic disorder has important implications as to the pathophysiological model of disease, its conceptualization and treatment.

“…According to this model, well-being should result from removal of distress. Yet, there is evidence both in psychiatric [6]and psychosomatic [7]research to call such views in question. A second reason is concerned with the conceptual model a psychotherapeutic approach should refer to.…”

Section: Introductionmentioning

confidence: 99%

Well-Being Therapy: Conceptual and Technical Issues

Fava

1999

Self Cite

266

136

Well-being therapy is a short-term, well-being-enhancing psychotherapeutic strategy. It is based on Carol D. Ryff’s multidimensional model of psychological well-being, encompassing environmental mastery, personal growth, purpose in life, autonomy, self-acceptance and positive relations with others. Its conceptual and technical issues are described. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological and psychotherapeutic treatments, in body image disorders and in psychosomatic medicine. The first validation studies appeared to be promising. The technique is in its preliminary stage of development and may undergo major changes in the next years. It is hoped it may herald a new trend of psychotherapy research and practice in the current symptom-oriented settings.