Fava GA, Freyberger HJ, Bech P, Christodoulou G, Sensky T, Theorell T, Wise TN. Diagnostic criteria for use in psychosomatic research. Psychotherapy and Psychosomatics. 1995; 63: 1-8

A team of interational experts has proposed a set of diagnostic criteria in psychosomatics. Among the different epistemologic and operative problems, the psychosomatic field has an important deficit in the domain of diagnosis. Psychosomatic diagnoses have been traditionally borrowed from the psychodynamic classification, as organic neurosis or conversion symptom. This diagnostic model was very poor because of several reasons, among which the lack of specificity in articulating psychological and pathophysiological mechanisms, and above all the idea that intrapsychic conflicts can cause somatic alterations.
The recent renaissance in psychiatric diagnosis has resulted in the widely accepted (beyond conflicts of viewpoints) DSM-IV and ICD-10. Nonetheless, the epistemologic shift from psychoanalysis to psychiatric has not substantially modified the situation of diagnosis in psychosomatics. Several insufficiencies have been shown in many empirical, clinical and epidemiologic for DSM-IV and ICD-10 categories related to the psychosomatic disorders, such as Somatoform Disorder and Psychological Factors Affecting Medical Conditions. Empirical studies have attempted to develop a psychosomatic model according to which some diseases are considered to be psychosomatic because of a similar psychologic profile of patients suffering from that particular disease. It is a line of reasoning which is opposite to psychoanalysis as regards its contents (since the psychosomatic feature is derived from a particular medical disease considered as psychosomatic, such as the peptic ulcer disease, differently form achalasia which is considered to be a pure organic disease). However, it is theoretically similar to psychoanalysis in the dualistic splitting of mind and body. On the contrary, current studies principally focused on the psychosocial characteristics, independently of the organic disease: a certain psychologic characteristic 'x' (as, for esample, abnormal illness behavior) is more prevalent in the medical condition a' (as, for example, irritable bowel syndrome) compared to the condition 'b' (colon cancer). This is not to say that colon cancer patients may have an abnormal illness behavior. As a consequence, the lack of diagnostic tools produce the underusage of therapeutic interventions aimed to underdiagnosed psychosomatic syndrome.
The authors have established diagnostic criteria for 12 psychosomatic syndromes (Diagnostic Criteria for Psychosomatic Research, DCPR) which are:
Alexithymia
Type A Behavior
Disease Phobia
Thanatophobia
Health Anxiety
Illness Denial
Functional Somatic Symptoms Secondary to a Psychiatric Disorder
Persistent Somatization
Conversion Symptom
Anniversary Reaction
Irritable Mood
Demoralization
The article provides diagnostic criteria for each psychosomatic syndrome. Some studies are currently in progress in order to evaluate the theoretical constructs (which have only face validity until now) and the prevalence rates of DCPR in different clinical settings.

 Kroenke K, Spitzer RL, deGruy VF, Hahn SR, Linzer M, Williams JBW, Brody D, Davies M. Multisomatoform Disorder. An alternative to Undifferentiated Somatoform Disorder for the somatizing patient in primary care. Archives of General Psychiatry. 1997; 54: 352-358

 The DSM-IV diagnostic criteria for Somatization Disorder are too restrictive when used in primary care where somatoform disorders or medically unexplained somatic symptoms are frequent, while the criteria for Undifferentiated Somatoform Disorder are overly inclusive. In a study on 1000 primary care patients (Primary Care Evaluation of Mental Disorders, PRIME-MD), the authors of this paper developed criteria for a new somatoform disorder called Multisomatoform Disorder, defined as 3 or more medically unexplained symptoms during the last month along with a long (at least 2 years) history of somatoform symptoms.
In this study, the authors have analyized data from PRIME-MD from 4 different sites on 1000 primary care patients with mean age of 55 years, 60% women, 58% white, whose main somatic disorder were hypertension (48%), arthritis (23%), diabetes (17%), and heart disease (15%). Patients were classified according to criteria of DSM-III-R and Multisomatoform Disorder, and administered the 20-item Short-Form General Health Survey (SF-20) which evaluates the health-related quality of life in 6 domains: physical, mental, social, role, pain, and general health perception.
The prevalence rate of Multisomatoform Disorder was 8.2%. Compared with mood and anxiety disorders, Multisomatoform Disorder was associated with a marker impairment in health-related quality of life.
The authors concluded that Multisomatoform Disorder produces psychosocial impairment at least as great as many Axis I disorders and should be given serious considerations as an alternative to Undifferentiated Somatoform Disorder. Furthermore, Multisomatoform Disorder have a large and independent effect on psyhcosocial impairment, so that it has to be considered as non alternative to coexisting anxious and mood disorders.
This paper is consistent with a widely spread opinion of criticism to official psychiatric classification as regards correctness and efficacy of psychosomatic diagnosis. By the analysis of a large epidemiologic US multicenter study, the Spitzer's group has proposed a new psychosomatic diagnosis which can 'catch' an important aspect of the somatizing patient: the polymorphous feature of symptoms given by the wide inter- and intrasubject variability of duration, frequency, location and intensity. These patients, frequently seen in primary care settings, have in common repeating and persistent symptoms. These features are not detected by DSM-IV criteria because they are too restrictive (Somatization Disorder) or overinclusive (Undifferentiated Somatoform Disorder).

 Moser G. Ulcerative colitis and psychosocial factors. The Italian Journal of Gastroenterology and Hepatology. 1997; 29: 387-394

 It is an editorial written by an authoritative Wien gastroenterologist for a journal which is deeply renewed in many aspects (editorial board, layout, contents), the formely Italian Journal of Gastroenterology. This is an updating and appropriate review of the last findings about an intestinal disease (ulcerative colitis, UC) classically considered as psychosomatic although nobody has been able to confirm empirically this view.
The subject is considered under 3 specific aspects.
1) Are there predisposing psychosocial factors to UC? The psychoanalytic-oriented psychosomatic hypothesis has been firstly proposed during '30s-'40s. The decline of psychoanalytic paradigm in psychosomatic has produced also a rapid decline of the thesis on the psychic etiology of UC. In 80s the psychosomatic thesis has been more and more criticized and a seminal paper of North et al in 1990 (a controlled review of all studies published until then) has put a definitive end to this chapter.
2) Psychosocial factors influence the clinical course of UC? During the '90s the focus of research shifted from the cause to the clinical course of UC. Many controlled studies led to the current conclusions according to which: i) psychosocial stress factors can influence the history of disease, ii) intestinal dismotility factors, similar to those observed in the irritable colon syndrome, may overlap to the classical symptoms of UC relapses (above all, abdominal pain and diarrhea), iii) psychosocial stress factors may contribute to dysregulation of the brain-gut axis (central and enteric nervous system) via the hypothalamic-pituitary-lymphocyte axis.
3) Has UC a psychosocial impact as it is a chronic ilness? Here the starting point is the opposite of the original one issued from the psychoanalytic hypothesis. UC is a severe chronic disease with intestinal manifestations socially embarrassing which may impair some important psychological function such as self-esteem and sense of control over own life. Several recent studies are leading to the conclusion that psychosocial stress is significantly associated to clinical activity and acute symptoms. This finding has deep consequences on psychosomatic study of UC because the presence or the absence of active symptomatology can bias the sample selecetion.

 Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S. Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. British Medical Journal. 1998; 316: 1196-1200

 The authors studied a very particular and interesting problem: the chronic abdominal pain in children. They advanced two main questions: 1) what kind of family have these children and how their parents may contribute to chronicity of this somatic disorder?, 2) are chronic abdominal pain children prone to develop somatization and psychiatric disorders in adulthood?
The authors used data of an epidemiologic survey on health started in 1946. Before entering the survey, children who were born in that year were stratified (one child with white-collar parents to 4 children with manual and agriculture worker parents) in order to fairly represent socio-cultural reality of post-World War II in Great Bretain. A cohort of 5362 children was followed-up for 43 years, with last data collected in 1989. Data were processed and the following variables were established: definition of cases of chronic abdominal pain (persistent symptomatology in all 3 evaluation periods at age 7, 11, and 15 years) versus controls (absence of symptomatology reported in any occasion); physical and mental health of the parents (parents were interviewed when their child was 15 years-old with the aim to assess physical illness and each parent's perception of her/his partner's health; besides, parents were administerd the Maudsley Personality Inventory to assess neuroticism); absence from school (from school records from the period 1952-56); childhood behavior and personality (from a questionnaire administered to the child's teachers and the Pintner Personality Inventory administered to the child when he was 13 years-old); adulthood physical and mental health (administration of a questionnaire on physical symptoms and the Present State Examination when the subject was 43 years-old).
The main results were: i) the parents of symptomatic children reported a significantly higher number of physical symptoms, ii) mothers of symptomatic children reported a significantly higher score for neuroticism, iii) the presence of abdominal pain in childhood was not a predictor of abdominal pain in adulthood but predisposes to suffer from a variety of physical symptoms, iv) the presence of abdominal pain in childhood is a strong predictor of psychiatric disorders in adulthood.
The authors concluded that chronic abdominal pain in childhood is associated with poor physical health in parents and poor mental health in mothers. The abdominal pain children are not more likely to suffer from the same symptom in adulthood but had a major risk to develop somatization and psychiatric disorders in adulthood.

 Journal of Psychosomatic Research. Vol.44, 1998. Special Issue: Panic disorder in general medicine. Guest Editor: Brian Baker

 This special issue (special guest Brian Baker from Toronto) of the Journal of Psychosomatic Research, affiliated to the International College of Psychosomatic Medicine (ICPM), addresses the topic of panic disorder in medicine.
Why panic disorder, which is classified as a psychiatric disorder, may concern psychosomatics? There are really many reasons. One reason concerns the definition of panic disorder which has its hallmark in the panic attack. DSM-IV criteria for panic attack are a period of intense fear associated with at least 4 of 13 symtpoms. Only 3 of the 13 symptoms are psychic in nature (derealization, fear of becoming crazy, fear of dying) while the others are physical symptoms. Thus, panic attack is a psychosomatic syndrome because of its definition, since one cannot have a panic attack without physical symptoms.
Another reason concerns the fact that the panic disorder patient firstly refers to the general practitioner and not to the psyhciatrist. Prevalence of panic disorder in general population is 1 (for men) - 3 (for women)%, while the rate is increased to 3-8% in primary care settings. As a consequence, the panic disorder patient overuses health care facilities at least 3 times more than the average patient who refers to primary care physicians 3-4 times per year at average. Strictly related to this behavior is the fact that the first clinical presentation of the panic disorder is physical with heart, neurologic, respiratory and gastrointestinal symptoms. So patients tend to rely on the general practitioner and/or specialists in cardiology, neurology, pneumonology and gastroenterology, and much less in psichiatry. As a general conclusion, panic disorder is poorly diagnosed while social costs increase in relation to the overprescription of examinations and treatment often unuseful.
This issue collectes review articles written by international experts in the field on the different clinical, epidemiologic and therapeutic aspects of the association between panic and somatic disorders.

 Sollner W, Zingg-Schir M, Rumpold G, Mairinger G, Fritsch P. Need for supportive counselling - The professionals' versus the patients' perspectives. A survey in a representative sample of 236 melanoma patients. Psychotherapy and Psychosomatics. 1998; 67: 94-104
(Wolfgang Sollner, MD. Leopold Franzens University of Innsbruck, Department of Medical Psychology and Psychotherapy, Sonnenburgstrasse 9, A-6020 Innsbruck (Austria). Tel: +43 512 586335, Fax: +43 512 5863356, E-mail: wolfgang.soellner@uibk.ac.at)

 Cancer deeply affects patients' quality of life and psychological wellbeing, and both patients and oncologists often require psychological interventions. However, the physician's request of specialistic psychological intervention may hide his need to avoid his emotional involvment in the relationship with patients. Oncologists usually require psychological interventions when patients and their loved ones show a high psychological distress. Little is known about the attitude of cancer patients towards psychological interventions.
The authors of this study, from the University of Innsbruck, Austria, aimed to investigate the interest of melanoma patients in a supportive counseling psychosocial intervention. A group of 215 melanoma patients has been evaluated with regard to psychological distress, coping strategies, social networks, and interest in receiving psychosocial support. Most of patients with severe distress (83%) wanted psychosocial support from their oncologist rather than a psychotherapist. In particular, patients showed fear of cancer progression and wanted to be sufficiently informed by their dermatologist. On the contrary, patients with poorer prognosis, receiving low levels of support from their social network, and exhibiting a depressive coping style showed particular interest in getting supplementary psychotherapeutic support.
The findings of this study clearly underline that oncologists should provide basic psychological support to their cancer patients, even if they do not exhibit severe distress. Furthermore, cancer patients who experience high cancer-related fears and who feel insufficiently informed should be offered more intensive emotional support by their physician, and not simply more information. This study stresses the importance of developping oncologists' communications skills and educating them to a more appropriate physician-patient relationhsip.

 Emdad R, Belkic K, Theorell T, Cizinsky S. What prevents professional drivers from following physicians' cardiologic advice? Psychotherapy and Psychosomatics. 1998; 67: 226-240
(Prof. Tores Theorell, PhD. National Institute for Psychosocial Factors and Health, Box 230, S-17177 Stockholm (Sweden). Tel: +46 8 7286961, Fax: +46 8 344143)

 One of the most important and less investigated aspects in psychosomatics concerns prevention. Some diseases have already well-established risk factors which are often behavioral rather than biomedical. For example, diet, smoking, and physical activity are behavioral risk factors for cardiovascular illnesses.
Several studies have shown that professional drivers are individuals particularly at risk for cardiovascular disorders. Their "cardiac risk factor profile"is generally high because of cigarette smoking, hypercholesterolemia, hypertriglyceridemia, overweight, and low levels of leisure time phisical activity. Furthermore, their work is stressing because of metropolitan traffic, road dangers and long and shifting working hours. The behavioral profile of an average professional driver is of a person with static physical activity, high distress, heavy smoking and bad eating.
The authors of this study, from the Karolinska Institute of Stockholm, Sweden, divided a group of professional drivers from municipal transit companies in 4 subgroups (subjects with ischemic heart disease, hypertension, borderline hypertension, and normotension) in order to investigate the effectiveness of a 6-month risk factor counseling prevention program on two cardiac risk factors, cigarette smoking and overweight. Baseline smoking intensity was best predicted by the total burden of occupational stress and number of smoking years. Baseline Body Mass Index was best predicted by long hours behind the wheel, low availability of attachment outside work and low self-reported job strain. After the 6-month counselling program, smoking cessation was associated to few smoking years, low coffee intake and admitting fear during driving. None of the heavy smokers decreased their daily number of cigarettes after 6 months. Losing weight was associated to higher leisure time physical acitivity, quitting or diminishing smoking, making significant life changes, particularly having interests outside the work environment, and making significant work-related changes, such as more regular working hours, improving in decision-making roles, better ergonomic work environment, feeling more appreciated from the company.
This study shows that exposure to occupational stressors, along with denial of job strain and low availability of social attachment outside work, could contribute to maintenance of maladaptive behavior in professional drivers, increasing risks for cardiovascular disorders. As a consequence, the change of lifestyle and work environment, particularly more active participation in work management and more regular scheduling of work shifts, are fundamental elements to be considered in designing counseling programs to prevent cardiovascular illnesses.

 Journal of Psychosomatic Research. Vol.45, no.3, 1998. Special Issue: Psycho-Oncology. Guest Editors: William Breitbart (Memorial Sloan-Kettering Cancer Center, New York) - Harvey Max Chochinov (University of Manitoba, Winnipeg, Canada)

 This special issue of the Journal of Psychosomatic Research is devoted to psycho-oncology. Psycho-oncology deals with different psychological, social, behavioral, and psychiatric issues to cancer prevention, cancer illness and treatment, and cancer survivorship. It is a field which has become much widespread during last years. The International Society of Psycho-Oncology has been formed in 1984. The journal Psycho-Oncology has been established in 1992. The latest world congresses (the third in New York in October 1996 and the fourth in Hamburg in September 1998) have been attended by more than 1,000 participants presenting hundreds posters and research articles.
This special issue includes 3 review articles and 5 research original papers. The review articles deal with group therapy in the cancer setting (F.I.Fawzy and N.W.Fawzy), the role of the clinical psychologist in gynecological cancer (E.Rieger, S.W.Touyz, G.V.Wain), and the assessment and the treatment of depression in the cancer patient (D.J.Newport and C.B.Nemeroff). The research papers deal with the psychological distress of the marital partner of the cancer patient (L.Baider, N.Walach, S.Perry, A.Kaplan De Nours), the disorders of persistent somatization in the cancer patient (S.K.Chaturvedi and P.Maguire), the relationship between awareness of cancer diagnosis and psychiatric morbidity (P.S.Chandra, S.K.Chaturvedi, A.Kumar, et al), the effects of participation to breast cancer support groups (M.J.Stevens and J.E.Duttlinger), the psychological correlates of fatigue in cancer patients undergoing radiotherapy (E.M.A.Smets, M.R.M.Visser,
B.Garssen, et al)

(Correspondence to: Dr. Jozef Janssens, Professor of Medicine, Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium)

- Valori R. Commentary. Ambulatory manometry in dyspepsia: walking a thin line. Gut. 1998; 42: 153-154
(Correspondence to: Dr. R.Valori, Consultant Gastroenterology, Gloucester Gastroenterology Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, United Kingdom)

- Ho KY, Kang JY, Yeo B, Ng WL. Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors. Gut. 1998; 43: 105-110
(Correspondence to: Dr. K.Y.Ho, Department of Medicine, National University Hospital, Lower Kent Ridge Road, Singapore 119074)

Recurrent functional dyspeptic symptoms (upper abdominal pain, vomiting, nausea, early satiety, postprandial bloating or fullness) and chest pain of non-cardiac origin are frequent clinical problems and very common in general population and medical settings. One of the major problems is that their biomedical causes are not known. Abnormal gastrointestinal motor function is thought to constitute a possible etiopathogenic mecahnism in symptom formation. Hence, researchers from the famous physiology school of Leuven (Belgium) (Prof. Janssens' group) have investigated gastrointestinal motor activity in patients with severe motility-like dyspepsia by means of new biomedical technologies (prolonged 24 hour ambulatory antrojejunal manometry and computer aided analysis). They found that even with the use of advanced computer aided analysis, it is not possible to identify a specific motor pattern which can discriminate dyspeptic patients from those with other diseases or even healthy individuals. In fact, they found a lot of abnormal motor activity in the absence of subjective symptoms, and 79% of the time, when there were symptoms, the tracings were normal. Since an advanced highly reliable and valid technology was used, the authors concluded that no association exists between gastrointestinal motility and functional symptoms. In his editorial, Dr. Valori pointed out that 15 years ago it was believed that motility studies would become to functional symptoms what endoscopy was (and still is) to ulcers, gallstones and cancer. Today this belief has been largely disconfirmed by well conducted laboratory studies. On the contrary, he stressed that the recent literature is suggesting more and more that somatization processes and psychosocial factors are more important driving force than the severity of symptoms in requiring a consultation.
Consistent with this research stream, another gastroenterologic research group investigated both abnormal oesophageal motor activity and psychiatric disorders in patients with non-cardiac chest pain. They studied a group of functional patients (no significant endoscopic findings, manometric abnormalities, or pathological oesophageal reflux) (Group 1) by comparing them with patients with the same symptom pattern but who was shown to have an organic cause (peptic ulcer and oesophagitis) (Group 2) and gallstone disease for which they were referred for elective cholecistectomy (Group 3). They found that functional patients in Group 1 had significant higher prevalence of at least one psychiatric disorder (51%) than gallstone patients in Group 3 (21%). On the contrary, no significant differences between functional (Group 1) and organic (41%) (Group 2) patients or between organic (Group 2) and gallstone (Group 3) patients. They concluded that patients with non-cardiac chest pain and no upper gastrointestinal organic disease may have a significant greater chance of suffering from a psychiatric disorder.
These recent three papers have something important in common: they have been all written by gastroenterologists and they, each one in its own perspective, show that a psychological assessment is necessary in functional patients. The consultant psychologist may become a basic professional specialist in gastroenterology practice and services because, as pointed out by Valori, s/he can "understand the nuances of consultation behaviour and the complex relationship of psychological distress to somatic symptoms". Finally, Gut's Editorial Board - one of the leading journal in gastroenterology - is to be commended for such an open-mind publication.

For years peptic ulcer disease (PUD) has been considered as "the" psychosomatic disorder. According to Alexander's wellknown model, when a vulnerable person - on grounds of personality and pepsinogen - encounters a major life stress, ulcer is suddenly born. This is a linear etiologic thinking way which has been disconfirmed by recent evidence about the role of Helicobacter pylori (HP) in the etiopathogenesis of many gastrointestinal disorders, including PUD. Since the discovery of HP, many currently conclude that psychological factors are unimportant at all. PUD is then shifted from a stigmatised psychosomatic cubbyhole into a more biomedical dignified infectious one. It is easy to recognize here a dichotomized thinking. As any dichotomy imposed to human and clinical sciences, also this dichotmised thinkings is showing its failures: more than 80% HP positive people never develop an ulcer while at least 10% of PUD patients have no HP infection. Thus, the question asked by Levenstein et al is: are there other factors along with HP causing PUD? is psychological stress one of these factors which remains as a valid one notwithstanding HP discovery? The authors show many evidences about the role of psychological stress in PUD from epidemiology, developmental biology, immunology, physiology, infectious disease. Furthermore, empirical and clinical findings suggest that HP infection and psychological stress may be addictive, independent and complementary rather than simply synergistic, so that these two pathways could inversely facilitate gastric acid damage in ulcer patients, though not necessarily in the general population.
The work of Susan Levenstein is important. She is a psychoanalyst who is engaged into research and clinical psychosomatics and works in a hospital gastroenterology service. She wonders why gastroenterologists so easily dismissed the contribution of psychological stress to ulcer formation in favour to the unique infectious hypothesis. The dichotomised thinking reflects the resistance to the difficult but essential task of considering disease etiology in an integrated biopsychosocial manner that incorporates both psychological and biomedical elements. This means that the "modern" infectious hypotehsis is clinically and empirically weak as was the "old" psychosomatic hypothesis: both of them postulates the mind-body dichotomy, which is what psychologists and physicians do not need any longer.

The research and clinical field of health-related quality of life (HRQL) is rapidly growing and has become an integral variable of outcome evaluation. In fact, over 1,000 new articles each year are indexed under HRQL. Notwithstanding the aknowledged importance of HRQL, confusion remains about how HRQL should be measured and intrepreted. This article is intended to provide a simple conceptual framework to describe the core elements of HRQL. The authors identified two operational defintions of HRQL: objective functioning - namely, the ability to perform common and/or disease-related particular tasks such as climbing stairs or walking - and subjective wellbeing - namely, the individual's subjective appraisal of his/her health status which include satisfaction, absence of psychological distress and social support.
While researches focused on physical ability and objective functioning in activities of day livings (as, for instance, the classic Karnofski Index in oncology), much recent interest has shifted towards the subjective wellbeing. It is thought that HRQL is inherently subjective because the patient has a privileged access to his/her own quality of life, outcome of disease and treatment, relation with his/her own everyday living. While scales assessing objective functioning should be carefully validated, chiefly as regards criterion and construct validity, measures of subjective wellbeing should pay a great deal of attention to confounding factors. For instance, subjects with high scores on neuroticism, hypocondriasis and somatization measures have been found to overreport poor wellbeing, so that HRQL scales administered to these subjects would be likely to assess negative affect rather than quality of life. Consistently, patients with mood or psychosomatic symptoms in primary care gave lower ratings for their perceived health than did patients with severe chronic diseases, such as diabetes or pulmonary disorders. In an opposite sense, many cancer patients may report a better perceived health status than healthy comparison groups. Such a paradox clearly reflects the psychological adaptation to the disease and the great estimation of life these patients may show.
The HRQL field may be considered as a distinct and complementary line of psychosomatics. While classic psychosomatic investigations focus on the etiology of disorders, the HRQL research is aimed to the integrated assessment of outcome of disorders along with other classic biomedical indices. However, both of these approaches study the mysterious interface between mind and body in the individual's health

Several studies have found many physiologic abnormalities of gastrointestinal (GI) functioning in patients with eating disorders. Cllinical experience suggests that GI disorders can coexist with eating disorder-related behaviors and even persist after the normalization of eating behavior. Since studies have investigated current GI disorders in patients with acute and severe eating disorders, the authors aimed to study the presence of lifetime eating disorders in patients with functional GI disorders (FGID) - functional dyspepsia, irritable bowel syndrome, functional abdominal pain - by comparing the lifetime prevalence of eating disorders in patients with acute gallstone disease for which they were referred for elective cholecistectomy. Past eating disorders, retrospectively assessed by DSM-IV criteria, were significantly more prevalent in FGID patients (15.7%) than in gallstone disease patients (3.1%), and FGID patients were found to be currently more psychologically distressed then comparison patients. When FGID patients with past eating disorders were compared to FGID patients without past eating disorders, they resulted to be more women, younger, more educated, more anxious and depressed, and had more severe GI symptoms.
This study suggest to carefully investigate past eating disorders in patients with current functional GI disorders. The empirical findings of this study is consistent with clinical experience. An underlying psychiatric disorder, such as a mood or anxiety disorder, may present different shifting symptoms over the time, may be classified under different rubrics and not recognized as a chronic distressing condition. This raises the possibility that the psychiatric or medical diagnosis is dependent on the temporal window of the observation of the patient's symptoms (periods of higher prevalence of mood or functional GI or eating disorders in the patient's life) and/or the kind of specialist (gastroenterologist, general practitioner, psychiatrist) who investigates the patient's symptoms. This is consistent with the frequent observation that anorexia and bulimia nervosa are probably psychiatric in origin but may have a prolonged phase that is substantially medical, marked by frequent GI symptoms