Functional somatic disorders: discussion paper for a new common classification for research and clinical use

BMC Medicine - Tập 18 Số 1 - 2020
Christopher Burton1, Per Fink2, Peter Henningsen3, Bernd Löwe4, Winfried Rief5
1Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield, UK.
2Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
3Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
5Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany

Tóm tắt

Abstract Background Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients’ quality of life and healthcare costs. Main body We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders. We propose ‘functional somatic disorders’ (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrum – and also within organ system-specific chapters of a classification – they should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD). Conclusion We propose a new classification, ‘functional somatic disorder’, which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders.

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Tập 18 Số 1

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