Somatoform disorders

According to DSM-IV those patients not meeting the criteria for anxiety or depressive disorders would likely be assigned to a somatoform disorder. These are a group of psychiatric syndromes characterized by medically unexplained symptoms, which are of presumed psychological origin. There are a number of subcategories.

• Somatization disorder (Briquet's syndrome) is used to describe patients who report multiple, recurrent, medically unexplained symptoms; a minority of patients with CFS will meet the criteria for this disorder.

• Hypochondriasis describes a syndrome in which the patient's main concern is with the possibility that they are suffering from an organic disease. Although on initial inspection this would seem to be applicable to many patients with CFS, the use of this diagnosis is problematic in the case of an illness, the cause of which is regarded as uncertain by doctors as well as patients. Furthermore, clinical experience suggests that most patients with CFS are more concerned about the symptoms and impaired functioning they are experiencing than about the precise medical diagnosis to which these symptoms are attributed. Therefore although the diagnosis of hypochondriasis has the advantage of explicitly including patients' illness beliefs and behaviour in its definition, existing diagnostic criteria do not readily fit the clinical phenomena of CFS.

• Almost all patients with CFS not meeting the criteria for any of the above DSM disorders are likely to fall into the undemanding residual category in DSM-IV of undifferentiated somatoform disorder'.

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