身心症在家庭醫學：DSM-5的診斷與實務

Somatic Symptom and Related Disorders in Family Medicine: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Diagnostic Criteria and Clinical Practice

身體型疾患(somatoform disorder)在門診中是經常被低估的問題，醫師在治療經驗上很少能察覺病因，在有限的門診時間內並不容易發現潛藏的問題。病人可能對於自己的身體不適感到焦慮而到處求醫，即使檢查沒有特殊發現，仍然擔心身體的問題。《精神疾病診斷與統計手冊》第5版(The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5)將身體型疾患歸類為身體症狀及相關障礙症(somatic symptom and related disorders)，包含身體症狀障礙症、罹病焦慮症、功能性神經症狀障礙症、人為障礙症、受心理因素影響的其他身體病況、其他特定的身體症狀及相關障礙症，以及非特定的身體症狀及相關障礙症。其診斷需獲取詳細的病史詢問和盡可能的側面資訊，初次看診的病人可對身體症狀先予以處理，建立關係後，再針對病人的心理層面詳加探索。身體症狀及相關障礙症的治療方面包含抗憂鬱劑藥物和心理治療，可能有治療的效果。

Somatoform disorder is often underdiagnosed and rarely perceived by physicians at outpatient clinics whose time-limited setting renders it difficult to further identify potential problems. Care-seeking behavior usually occurs when patients feel disproportionately anxious about their uncomfortable symptoms without diagnostic findings. In the new edition of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), somatoform disorder is incorporated in the category of “somatic symptom and related disorders,” which mainly constitute somatic symptom disorder, illness anxiety disorder, psychological factors affecting medical condition, functional neurological disorder, factitious disorder, other specified somatic symptom and related disorder, and unspecified somatic symptom and related disorder. Diagnosis of these disorders requires detailed inquiry into patients’ comprehensive medical history and collection of supplementary information as much as possible. Physicians should consider treating the physical symptoms first during the initial interview and saving the examination of underlying psychological causes for later meetings after rapport with patients are established. Antidepressants and/or psychotherapy may be beneficial in treating somatic symptom and related disorders.