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somatization disorder diagnostic criteria

Somatization Disorder Diagnosis
As a diagnostic entity, somatization disorder is a fairly recent addition to the DSM nomenclature and was intended as a simplified version of Briquet’s syndrome. Somatization disorder was officially recognized in DSM-III and was also included in DSM-III-R with some minor changes. Before DSM-III, the criteria for Briquet’s syndrome required at least twenty-five of sixty physical symptoms without clear organic explanation from at least nine out of ten symptom groups. It should be emphasized that the number of symptoms required for somatization disorder had been established arbitrarily rather than empirically. In an attempt to be nonsexist, DSM-III-R required the presence of at least thirteen physical symptoms for both men and women; in DSM-III, the diagnosis of somatization disorder required twelve physical symptoms for men and fourteen physical symptoms for women. The DSM-IV requires eight physical symptoms to diagnose somatization disorder.
The current diagnostic criteria for somatization disorder are listed in Table 1. The criteria for somatization disorder proposed in DSM-IV have fared well in DSM field trials. Yutzy et al. examined the concordance between the proposed diagnostic criteria for DSM-IV somatization disorder and DSM-III-R, DSM-III, Perley–Guze, and the International Classification of Diseases-10 criteria in 353 female patients recruited from five sites; recruitment procedures were designed to maximize sociocultural, ethnic, and geographic diversity. The ICD-10 criteria agreed poorly with all other diagnostic sets including DSM-IV, which is consistent with other work. Yutsy et al. found that the DSM-IV criteria were an accurate and simpler method for diagnosing somatization disorder and had excellent concordance with DSM-III-R criteria. The authors reported that the DSM-IV criteria did not require special expertise in administration. Of note, no racial differences were observed as a result of any of the criteria sets used.
However, the determination of which criteria are best in diagnosing somatization disorder depends on the specificity and sensitivity of the criteria. Sensitivity is defined by the proportion of true cases correctly classified, and specificity is defined by the proportion of true noncases classified. Bucholz et al. compared the sensitivity, specificity, and positive predictive value (proportion of test positives who are truly positive) of DSM-IV criteria, a DSM-III-R seven-item symptom screen, and Swartz, Blazer, George, and Landerman’s eleven-item screen. The authors found that no one set of criteria was clearly superior and that selection criteria should be based on the intended application. For example, the results indicated that DSM-IV criteria for somatization disorder had almost perfect specificity and the highest predictive value of all screening sets, but sensitivity calculations yielded 33 to 50% missed cases.

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