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Author for correspondence: Anne Toussaint, E-mail: [email protected]
Introduction
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) changed the diagnostic category of somatoform and related disorders to somatic symptom and related disorders (SSD). This revision fundamentally shifted the way somatoform disorders are defined (Dimsdale et al., 2013). While medically unexplained symptoms were a key feature of somatoform and related disorders in DSM-IV (APA, 2000) and ICD-10 (WHO, 1992), SSD does not require the persistent symptoms to be medically unexplained. Regardless of their etiology, SSD is characterized by somatic symptoms that are either very distressing for the patients or result in significant disruption of daily functioning (A criterion). To be diagnosed with SSD, the individual must additionally experience excessive and disproportionate thoughts, feelings, and behaviors associated to the somatic symptoms (B criteria) which typically persist at least for 6 months (C criterion).
These new diagnostic criteria have been widely discussed. They are criticized as being too liberal, raising fears about mislabeling patients with comorbid medical illness as having a mental disorder (Frances and Chapman, 2013). In addition, the positive psychological criteria lack an empirical foundation (Rief and Martin, 2014).
DSM-5 in fact predicts a higher prevalence for SSD than for the former somatization disorder in the general population, but a lower prevalence then for undifferentiated somatoform disorders, rating around 5% and 7% (APA, 2013). Based on these numbers, SSD is one of the most common mental health disorder in medical settings and the general population (Fink et al., 1999; De Waal et al., 2004; Hiller et al., 2006). Patients usually show high levels of health care use, resulting in repeated investigations and treatment, which cause high socio-economic costs (Jacobi et al., 2004). Recently, SSD is proposed as a perceptual disorder (Henningsen et al., 2018) in which adverse events, dysfunctional cognitions, expectations, negative affectivity, or maladaptive behaviors influence the perception, perpetuation, and deterioration of somatic symptoms (Löwe and Gerloff, 2018). Since their clinical relevance is high, strategies to improve an early identification of patients with high symptom burden are essential (Kohlmann et al., 2013). The correct diagnostic label cannot only legitimize the patients’ concerns but also enable a targeted treatment (Murray et al.,...