title: Evaluating new proposals for the psychiatric classification of patients with multiple somatic symptoms.
abstract: OBJECTIVE
  The current DSM-IV classification of somatoform disorders has been criticized, and several new proposals for classification have been suggested (e.g., DSM-V work group: complex somatic symptom disorder [CSSD]). Our aim was to empirically validate and compare new proposals for the classification of people with multiple somatic complaints.
  
  
  METHODS
  Three hundred twenty-one participants were selected from a general population sample of more than 2500; half were selected from a subgroup with increased somatization scores (Patient Health Questionnaire 15-item somatic symptom subscale). Clinical and psychological variables and health care use were assessed with interviews and self-ratings to validate the new proposals. In addition, a high-risk group was defined to check whether new classification proposals could identify people in this a priori defined group; criteria for this high-risk group were disabling medically unexplained somatic symptoms and increased health care use. To analyze the stability of the syndromes, participants were recontacted 1 year later (completion rate, 76%).
  
  
  RESULTS
  The DSM-V proposal for CSSD shows good validity in the identification of people with disability and people requiring medical treatment. It is still restrictive but to a much lesser degree than the current somatization disorder: 29% of our a priori high-risk group was identified, whereas none of the participants fulfilled criteria for somatization disorder. For most proposals, the temporal stability is satisfactory yet substantially lower than expected for clinical samples. Classification criteria that include psychological features are advantageous in identifying people with health care needs.
  
  
  CONCLUSIONS
  Whereas some validation criteria for the new proposals (including CSSD) are satisfactory, most of the new proposals are still restrictive.
authors: Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany. rief@staff.uni-marburg.de
authors: Winfried
authors: W
authors: Rief
authors: Ricarda
authors: R
authors: Mewes
authors: Alexandra
authors: A
authors: Martin
authors: Heide
authors: H
authors: Glaesmer
authors: Elmar
authors: E
authors: Brähler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016584:Panic Disorder / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult