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In a recent issue of the ARCHIVES, Simon and Gureje1 reported on the stability of the symptoms and diagnosis of somatization disorder (SD). The authors found that the diagnosis of SD was not stable and that progressively, significant discrepancies were found in somatic symptom reporting.
Given that some of their data seemed to be restricted in range, we wondered whether alternative conceptualizations of somatization2 - 3 would yield higher stability estimates. To explore this issue, we reanalyzed the data reported by the authors in their Table 1 and Table 2, using a Monte Carlo method4 for estimating the stability of somatization over time.
Based on the data in their Table 1, we estimated the stability of SD to be between 0.18 and 0.37 using Kendall τ-b (95% confidence interval). However, for the data in the table "Number of Lifetime Somatization Symptoms Reported at Follow-up Assessment According to Number Reported at Baseline," the 95% confidence interval for τ-b was between 0.49 and 0.55. Clearly, the SD diagnosis is considerably less stable than is the total number of somatic symptoms reported.
To examine how alternative conceptualizations of somatization (ie, the presence of multiple medically unexplained somatic symptoms) might fare in this instance, we reconfigured the authors' presentation of data (originally a 4 × 4 array) into a 2 × 2 array, collapsing 0 to 6 symptoms as 1 category and 7 or more symptoms as the other category. The Kendall τ-b for this reconfigured table was estimated to be between 0.44 and 0.53.
Although it may be true that there is little diagnostic stability when DSM-IV criteria are used to define SD, we conclude that there is greater stability when somatization is simply defined as "high levels of unexplained physical symptoms." While these results do not gainsay the authors' contention that SD itself is an unstable entity and that the use of lifetime symptom reporting may be methodologically problematic, it does correct the misleading impression that somatization as a phenomenon is inherently unstable, particularly when more broadly defined. Thus, what is relatively stable for the long-term is the patient's propensity to have (or not have) multiple medically unexplained somatic complaints. However, we agree with the authors that any single complaint by a patient with somatization may be ephemeral.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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