Medically Unexplained Symptoms And Somatoform Disorders: Diagnostic Challenges To Psychiatrists

ORIGINAL

ARTICLE

Medically Unexplained Symptoms and Somatoform
Disorders: Diagnostic Challenges to Psychiatrists
Cheng-Ta Li1, Yuan-Hwa Chou1,2, Kai-Chun Yang1, Cheng-Hung Yang1,2,
Ying-Chiao Lee1,2, Tung-Ping Su1,2*
1

Department of Psychiatry, Taipei Veterans General Hospital, and 2Division of Psychiatry,
National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.Background: Clinical limitations of the criteria of somatoform disorders (SDs) have been criticized. However, little objective evidence supports this notion. We aimed to examine the prevalence of SDs in a population with medically unexplained symptoms (MUS), which was expected to have higher probabilities meriting such diagnoses, and to evaluate
factors that may influence the clinical judgmentof psychiatrists.
Methods: Data of subjects with MUS (n = 101, 9.5%) as their chief consulting problems, of 1,068 consecutive ethnic
Chinese adult medical inpatients referred for consultation-liaison psychiatry services, were reviewed. Psychiatric diagnoses including SDs and clinical variables were collected. Those with SDs were followed-up 1 year later, and structured
interviews were applied.Results: Patients with MUS had a high level of psychiatric comorbidity, especially depression (35.6%) and anxiety disorder (29.7%), rather than SDs (9.9%). Most diagnosed with SDs suffered from persistent MUS at the 1-year follow-up.
Pain was the most common presentation of MUS. Most of the subjects diagnosed with SDs were female and younger,
with multiple painful sites at presentation, nopast psychiatric diagnosis and no comorbid organic diagnoses. The diagnosis of SDs was seldom given in those with simultaneous MUS and mood symptoms.
Conclusion: A significant proportion (9.5%) of patients in psychiatric consultation suffered from MUS, and most were
comorbid with depression and anxiety. The identification of SDs was made in only 9.9%. Because MUS are associated
with a high rateof mental comorbidities, psychiatric consultations while facing such clinical conditions are encouraged.
[J Chin Med Assoc 2009;72(5):251–256]
Key Words: consultation, medically unexplained symptoms, pain, psychiatry, somatoform disorders

Introduction
Somatic symptoms are frequently encountered by clinicians in primary care; a significant proportion of them,
at least 1 third, are importantfor consultation-liaison
(C-L) psychiatrists if presenting as symptoms that cannot be well explained by general medical conditions.1
Patients suffering from these medically unexplained
symptoms (MUS) have increased risks of disease burden, disability, higher medical costs, mental and physical comorbidities and a poor quality of life.2,3 For the
benefit of both psychiatry and medicine, mucheffort
has been made to solve problems such as adequate
diagnoses and psychiatric comorbidities.

The term somatoform disorders (SDs) was first
introduced in the Diagnostic and Statistical Manual
of Mental Disorders, 3rd edition (DSM-III) in 1980,4
and remains the current classification of both the
DSM-IV-TR (text revision of the DSM 4th edition)
and the 10th revision of the InternationalClassification of Diseases (ICD-10). It was defined that
patients with MUS are associated with psychological
distress and repeated treatment-seeking behaviors.
The development of the criteria should have facilitated the management of somatized patients for all
doctors in clinical practice; however, many researchers5–8 have raised questions, finding such a classification
unsatisfactory forboth the clinicians and the patients

*Correspondence to: Dr Tung-Ping Su, Department of Psychiatry, Taipei Veterans General Hospital,
201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
Received: November 25, 2008
Accepted: March 30, 2009
E-mail: tpsu@vghtpe.gov.tw
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J Chin Med Assoc • May 2009 • Vol 72 • No 5
© 2009 Elsevier. All rights reserved.

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