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April 1997

Multisomatoform Disorder: An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care

Author Affiliations

From the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Drs Spitzer and Williams and Mr Davies); Department of Family Practice, University of South Alabama College of Medicine, Mobile (Dr deGruy); and Departments of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (Dr Hahn), University of Wisconsin Medical School, Madison (Dr Linzer), and Medical College of Pennsylvania and Hahnemann University, Philadephia (Dr Brody).

Arch Gen Psychiatry. 1997;54(4):352-358. doi:10.1001/archpsyc.1997.01830160080011

Background:  For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (≥2 years) history of somatization.

Methods:  Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; selfreported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter.

Results:  Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were enrolled in the Primary Care Evaluation of Mental Disorders Study. Compared with mood and anxiety disorders, multisomatoform disorder was associated with comparable impairment in health-related quality of life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty.

Conclusions:  Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.