Bodily distress syndrome: A new diagnosis for functional disorders in primary care?

BMC Family Practice

Debate

Per Fink¹  Andreas Schröder¹  Anna Budtz-Lilly²  Mogens Vestergaard²  Marianne Rosendal²  Mette Trøllund Rask² 

[1] Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark;Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark;

关键词: Bodily distress syndrome;    Functional disorders;    General practice;    Diagnosis;    Diagnostic utility;    Diagnostic validity;    Medically unexplained symptoms;   

DOI  :  10.1186/s12875-015-0393-8

 received in 2015-06-08, accepted in 2015-12-03,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundConceptualisation and classification of functional disorders appear highly inconsistent in the health-care system, particularly in primary care. Numerous terms and overlapping diagnostic criteria are prevalent of which many are considered stigmatising by general practitioners and patients. The lack of a clear concept challenges the general practitioner’s decision-making when a diagnosis or a treatment approach must be selected for a patient with a functional disorder. This calls for improvements of the diagnostic categories. Intense debate has risen in connection with the release of the fifth version of the ‘Diagnostic and Statistical Manual of Mental Disorders’ and the current revision of the ‘International Statistical Classification of Diseases and Related Health Problems’. We aim to discuss a new evidence based diagnostic proposal, bodily distress syndrome, which holds the potential to change our current approach to functional disorders in primary care. A special focus will be directed towards the validity and utility criteria recommended for diagnostic categorisation.DiscussionA growing body of evidence suggests that the numerous diagnoses for functional disorders listed in the current classifications belong to one family of closely related disorders. We name the underlying phenomenon ‘bodily distress’; it manifests as patterns of multiple and disturbing bodily sensations. Bodily distress syndrome is a diagnostic category with specific criteria covering this illness phenomenon. The category has been explored through empirical studies, which in combination provide a sound basis for determining a symptom profile, the diagnostic stability and the boundaries of the condition. However, as bodily distress syndrome embraces only the most common symptom patterns, patients with few but impairing symptoms are not captured. Furthermore, the current lack of treatment options may also influence the acceptance of the proposed diagnosis.SummaryBodily distress syndrome is a diagnostic category with notable validity according to empirical studies. Nevertheless, knowledge is sparse on the utility in primary care. Future intervention studies should investigate the translation of bodily distress syndrome into clinical practice. A particular focus should be directed towards the acceptability among general practitioners and patients. Most importantly, it should be investigated whether the new category may provide the basis for better treatment and improved clinical outcome.

【 授权许可】

CC BY   
© Budtz-Lilly et al. 2015