Unexplained somatic symptoms: an undefined field betwen psychiatry and internal medicine

José Atílio Bombana About the author

Clinical features characterized by symptoms unexplained by general medical conditions are very common in the clinical practice, accounting for a quarter to half of visits in both primary and secondary medical care facilities. They are currently classified as somatoform disorders (SD) in psychiatry, and as functional somatic syndromes (FSS) in Internal medicine. The diagnostic category of SD has been questioned, and its exclusion has even been proposed in future international classifications. FSS are characterized by symptoms, suffering and incapability rather than by specific diseases, and include but are not limited to fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, and several pain syndromes. Overlapping of clinical features raises the question of whether one or several diagnoses are present, both among different FSS and between FSS and SD, also pointing to the comorbidity issue. The same patient may be diagnosed with SD when seen by a psychiatrist, but when referred to a general practitioner he/she could be diagnosed with FSS. An overlapping field is presented, suggesting that modifications should occur in terms of conceptualization, diagnostic classification and therapeutic approach. The study of medically unexplained symptoms demonstrates the need for integrated approaches. Some related experiences of the Program of Care and Studies on Somatization (Universidade Federal de São Paulo [UNIFESP]) are presented.

somatoform disorders; fibromyalgia; diagnosis; comorbidity

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