Epidemiology

Somatoform illness is a ubiquitous phenomenon, representing one of the most common categories of illness encountered within the health care system. Precise prevalence estimates vary enormously due to the different diagnostic criteria employed across studies. In general, prevalence estimates decrease as symptoms become more severe, chronic, and greater in number. Recent evidence suggests that approximately 25% of patients attending primary care have a history of four or more unexplained symptoms. In contrast, studies have estimated the prevalence of DSM-IV somatization disorder (defined as a history of eight symptoms across multiple bodily sites) to be between 3 and 5% of primary care attenders. Within the neurological domain, evidence suggests that between 20 and 60% of new inpatient admissions have symptoms that cannot be fully accounted for by organic factors.

The understandable reluctance of many physicians to make formal somatoform diagnoses suggests that current data may underestimate the true prevalence of unexplained medical symptoms. In addition, many patients with diagnoses such as chronic fatigue syndrome, fibromyalgia, and noncardiac chest pain may be more appropriately viewed as having somatoform illness.

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