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A Biological Substrate for Somatoform Disorders: Importance of Pathophysiology

From the Department of Psychiatry (J.E.D.), University of California, San Diego, San Diego, California; and the Department of Pathology (R.D.), University of Illinois College of Medicine, Urbana-Champaign, Illinois.

Address correspondence to Joel E. Dimsdale, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0804. E-mail: jdimsdale{at}ucsd.edu

ABSTRACT

Somatoform disorders are troubling to both patients and physicians. The diagnosis regrettably relies on the presence of subjective distress in the absence of objective findings. As a result, there is always the possibility that a diagnosis will be "missed." There is a clear underlying physiology of distress, which implies that there is a two-way street—both psychosomatic and somatopsychic in terms of production and experience of somatoform symptoms. Studies on communication pathways from the immune system to the brain provide exciting new information on the pathophysiology of inflammation-associated symptoms.

Key Words: psychiatric diagnosis • somatoform disorder • inflammation • pain • fatigue

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