Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 7;10(1-4):10-18.
doi: 10.1159/000536668. eCollection 2024 Jan-Dec.

Psychobehavioral B-Criteria of Somatic Symptom Disorder Are Associated with Somatic Symptom Reporting in a Large Sample of Psychosomatic Outpatients

Matthias Hoheisel  1 , Stoyan Popkirov  2 , Rosa Michaelis  3 , Matthias Rose  1
Affiliations

Psychobehavioral B-Criteria of Somatic Symptom Disorder Are Associated with Somatic Symptom Reporting in a Large Sample of Psychosomatic Outpatients

Matthias Hoheisel et al. Complex Psychiatry. .

Abstract

Introduction: Somatic symptom disorder (SSD) as introduced by the DSM-5 is characterized by chronic somatic symptoms not fully explained by underlying pathology and accompanied by psychological factors, the diagnostic B-criteria. These cognitive, affective, and behavioral disturbances are related to increased attention to somatic symptoms. However, there is a lack of empirical evidence regarding the association between the B-criteria and high symptom reporting in clinical settings.

Methods: This 12-year retrospective, cross-sectional, observational study examined 6,491 patients from a German psychosomatic outpatient center. The somatoform subscale of HEALTH-49 was used to evaluate somatic symptom reporting. Excessive health concerns and other potential criteria associated with symptom reporting were determined using the ICD-10-Symptom Rating and other HEALTH-49 subscales.

Results: Regression analysis revealed that the established B-criteria for SSD were the strongest factors associated with somatic symptom reporting, with a standardized beta-coefficient of β = 0.31 (R2 = 0.428, df = 24, F = 187.886). Other psychobehavioral factors were clearly less associated with somatic symptom reporting, such as depressive symptoms with β = 0.15 and impaired activity and participation with β = 0.12. Sociodemographic factors, such as age (β = 0.16) and gender (β = 0.12), were also independently associated with somatic symptom reporting.

Conclusion: This study provides evidence for the concept of SSD related to specific B-criteria associated with somatic symptom reporting, based on a large patient sample. These results point to an important role of psychological symptomatology in patients with somatic symptoms. The findings also suggest that additional factors contribute to the reporting of somatic symptoms. Our results may inform future diagnostic criteria for SSD.

Keywords: Bodily distress disorder; Functional somatic syndromes; Psychological risk factors; Somatic symptom disorder; Somatoform disorders.

Plain language summary

This scientific study examines the association between psychobehavioral factors and somatic symptom reporting in a large sample of psychosomatic outpatients. We investigated the association of established and possible additional psychobehavioral criteria for somatic symptom disorder (SSD) as defined in the DSM-V. The study included 6,491 patients from a psychosomatic outpatient center over a 12-year period. The participants completed self-report questionnaires to assess somatic symptom reporting and psychobehavioral factors. The results showed that the B-criteria of SSD were associated with somatic symptom reporting, indicating the validity of these criteria in clinical practice. Other psychobehavioral factors, such as depressive symptoms and impaired activity and participation, as well as sociodemographic factors such as age and gender were also associated with somatic symptom reporting but to a much lesser extent. This study has limitations, including its retrospective and cross-sectional design, reliance on self-report measures, and the need for further research using longitudinal data and clinician-rated assessments to complement self-report data. However, our research highlights the importance of psychological symptomatology in individuals who report somatic symptoms. These findings may inform future diagnostic criteria and treatment approaches for individuals with SSD and improve treatment and patient outcomes.

PubMed Disclaimer

Conflict of interest statement

M.H. received book royalties (Hogrefe) and speaker fees. S.P. received book royalties (Springer Nature) and speaker’s fees. R.M. received book royalties (Pabst, Hippocampus) and speaker fees. M.R. received book royalties and speaker fees.

Figures

Fig. 1.
Fig. 1.
Standardized β-coefficients with standardized bootstrapped 95% confidence intervals.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Löwe B, Spitzer RL, Williams JBW, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008;30(3):191–9. - PubMed
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Publishing; 2013.
    1. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, et al. . Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013;75(3):223–8. - PubMed
    1. Löwe B, Levenson J, Depping M, Hüsing P, Kohlmann S, Lehmann M, et al. . Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis. Psychol Med. 2022;52(4):632–48. - PMC - PubMed
    1. Löwe B, Mundt C, Herzog W, Brunner R, Backenstrass M, Kronmüller K, et al. . Validity of current somatoform disorder diagnoses: perspectives for classification in DSM-V and ICD-11. Psychopathology. 2008;41(1):4–9. - PubMed