MULTISOMATOFORM DISORDER - AN ALTERNATIVE TO UNDIFFERENTIATED SOMATOFORM DISORDER FOR THE SOMATIZING PATIENT IN PRIMARY CARE

Background: For clinical or research use in primary care, the DSM-IV d iagnostic criteria For somatization disorder are too restrictive, whil e the criteria for undifferentiated somatoform disorder are overly inc lusive. In this article, we examine the validity of multisomatoform di sorder, defined as 3 or more medically unexplained, currently botherso me physical symptoms plus a long (greater than or equal to 2 years) hi story of somatization. Methods: Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites w ere analyzed. The outcomes assessed were 6 domains of health-related q ualify of life, using the 20-item Short-Form General Wealth Survey. se lf-reported disability days and health care use; satisfaction with car e; and physician-rated difficulty of the encounter. Results: Multisoma toform disorder was diagnosed in 82 (8.2%) of the 1000 patients who we re 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 li fe, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty. Conclusions: Multisomatoform d isorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, becaus e multisomatoform disorder has a large and independent effect on impai rment, its diagnosis should not be precluded simply because of a coexi sting mood or anxiety disorder.