| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SOMATIC PRESENTATIONS: OVERVIEW |
Department of Psychiatry, University of California, San Diego, San Diego, CA (Dimsdale)
London School of Hygiene and Tropical Medicine, London, UK (Patel)
Peking University, Beijing, China (Xin)
Department of Anthropology, Harvard University, Cambridge, MA (Kleinman)
This special section of Psychosomatic Medicine presents a series of brief overviews concerning one of the most challenging areas of psychiatric diagnosis. Somatic presentations are arguably present in virtually every psychiatric diagnosis, but they are particularly evident in the highly disparate diagnoses of somatization disorder, somatoform disorder, conversion disorder, pain disorder, hypochondriasis, body dysmorphic disorder, and psychological factors affecting medical conditions.
How distress is "embodied" is one of the central challenges of contemporary psychiatry. Our epidemiological knowledge base is limited, particularly in the developing world. Thus, cross-cultural insights, although fervently desired, are based on limited data. Even in Europe and the United States, contemporary epidemiological studies rarely sample somatic issues thoroughly, instead focusing, if at all, on the relatively rare occurrence of somatization disorder. Studies describing and comparing the phenomenology, natural history, and treatment response of the current categories of mental disorders with prominent somatic presentations are scarce. Similarly, there are few studies utilizing contemporary neural imaging tools and neural immune probes for understanding these complex illnesses that are so frequently associated with relatively nonspecific somatic symptoms. The conceptual "borders" between these somatic presentations and other psychiatric disorders, such as depressive disorders, are also ill defined.
This set of papers, written by international experts from different backgrounds, highlights some of the many challenges involved in diagnosing psychosomatic phenomena in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V). In general, the papers stem from a landmark meeting in Beijing in September 2006. Two of the papers provide context for this special section. The paper by Regier (1) describes the overall process by which the American Psychiatric Association, the National Institutes of Health, and the World Health Organization are working together to craft the next DSM that will also be more convergent with International Classification of Diseases. The paper by Oken (2) summarizes how psychosomatic disorders have been dealt with in successive versions of the DSM. The rest of the papers discuss culture (3–5), epidemiology (6,7), comorbidity (8,9), biology (10), and treatment (11–13) of these puzzling disorders.
Efforts to standardize psychiatric diagnosis are relatively recent phenomena. As such, accumulating knowledge from the diverse disciplinary perspectives, which characterize modern psychiatry, and from across the world will determine our understanding of the diagnostic boundaries of somatoform presentations. We can perhaps have tolerance for the shortcomings of our efforts to achieve diagnostic clarity if we recall how long it has taken to map the world geographically. We hope that this set of papers will provide some navigational assistance to the ongoing work in developing an improved DSM.
Drs. Dimsdale, Patel, Xin, and Kleinman served as guest editors for this collection of papers.
NOTES
This article is being co-published by Psychosomatic Medicine and the American Psychiatric Association.
DOI:10.1097/PSY.0b013e31815b005d
REFERENCES
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
