Assessing somatization disorder in the Chronic Fatigue Syndrome (CFS)

This study was conducted to examine the rates of somatization

disorder (SD) in the chronic fatigue syndrome (CFS) relative

to other fatiguing illness groups. It further addressed the

arbitrary nature of the judgments made in assigning

psychiatric vs. physical etiology to symptoms in controversial

illnesses such as CFS. Patients with CFS (N = 42), multiple

sclerosis (MS) (N = 18), and depression (N = 21) were compared

with healthy individuals (N = 32) on a structured psychiatric

interview. The SD section of the Diagnostic Interview Schedule

(DIS) III-R was reanalyzed using different criteria sets to

diagnose SD. All subjects received a thorough medical history,

physical examination, and DIS interview. CFS patients received

diagnostic laboratory testing to rule out other causes of

fatigue. This study revealed that changing the attribution of

SD symptoms from psychiatric to physical dramatically affected

the rates of diagnosing SD in the CFS group. Both the CFS and

depressed subjects endorsed a higher percentage of SD symptoms

than either the MS or healthy groups, but very few met the

strict DSM-III-R criteria for SD. The present study

illustrates that the terminology used to interpret the

symptoms (ie, psychiatric or physical) will determine which

category CFS falls into. The diagnosis of SD is of limited use

in populations in which the etiology of the illness has not

been established.

Johnson SK, DeLuca J, Natelson BH

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