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Article |

Multisomatoform Disorder:  An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care

Kurt Kroenke, MD; Robert L. Spitzer, MD; Frank V. deGruy III, MD; Steven R. Hahn, MD; Mark Linzer, MD; Janet B. W. Williams, DSW; David Brody, MD; Mark Davies, MS
Arch Gen Psychiatry. 1997;54(4):352-358. doi:10.1001/archpsyc.1997.01830160080011.
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Background:  For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (≥2 years) history of somatization.

Methods:  Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; selfreported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter.

Results:  Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were 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 life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty.

Conclusions:  Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.

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