title: Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings.
abstract: A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11. BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations. This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability.
  
  
  
  PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability.
  
  
  
  Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability.
  
  
  
  Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.
authors.affiliation: Institute of Psychiatry, London, United Kingdom. Electronic address: davidpgoldberg@yahoo.com.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldberg
authors.affiliation: World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University, New York, NY, USA.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Reed
authors.affiliation: National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico, DF, Mexico.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Robles
authors.affiliation: University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Bobes
authors.affiliation: University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain.
authors.forename: Celso
authors.initials: C
authors.lastname: Iglesias
authors.affiliation: Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Sandra
authors.initials: S
authors.lastname: Fortes
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Jair
authors.initials: J
authors.lastname: de Jesus Mari
authors.affiliation: University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Tai-Pong
authors.initials: TP
authors.lastname: Lam
authors.affiliation: Institute of Psychiatry, Rawalpindi, Pakistan.
authors.forename: Fareed
authors.initials: F
authors.lastname: Minhas
authors.affiliation: Institute of Psychiatry, Rawalpindi, Pakistan.
authors.forename: Bushra
authors.initials: B
authors.lastname: Razzaque
authors.affiliation: National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico, DF, Mexico.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Garcia
authors.affiliation: Research Unit for General Practice, University of Southern Denmark, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosendal
authors.affiliation: University of Otago, Wellington, New Zealand.
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Dowell
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: Sebastian Kolowa Memorial University, Lushoto, Tanzania.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Mbatia
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008297:Male; D000071896:Medically Unexplained Symptoms; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D011320:Primary Health Care; D011594:Psychometrics; D013001:Somatoform Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D014944:World Health Organization
keywords: Bodily stress syndrome; Classification; Health anxiety; ICD; Mental disorders; Primary care