Somatic Symptom Disorder according to DSM-5: development and validation of a new self-report measure (SSD-B)

2013年5月，美国精神病学协会发布了最新版的《精神疾病诊断与统计手册》：DSM-5。该版本包括在躯体型疾病领域的显著改进，以提高诊断的可靠性和临床效用。特别是，新的躯体症状障碍不再包括有争议的需要有机的可解释性的症状。相反，伴随身体症状的至少一个相关的积极心理特征（B标准）的存在是必需的：(1)对自己症状的严重性的不成比例的和持续的想法，(2)对健康或症状的持续高度焦虑，(3)将过多的时间和精力投入到这些症状或健康问题上。早期诊断这些患者以防止慢性化、不适当的卫生保健使用和改善患者护理至关重要。虽然它们不能替代DSM-Disorders的黄金标准结构化临床访谈，但自我报告问卷可以是一种实用而有效的诊断辅助。有评估身体症状的量表（例如PHQ-15），然而，目前没有直接评估新B标准的问卷。我们项目的目标是为此目的开发一种可靠和有效的仪器。到目前为止，一个初步版本（SSD-B）已经开发出来，并在一个试点门诊心身样本（n = 156）上进行了测试。验证性因素分析证实了最初根据三个子标准形成的12项精细化版本的三因素结构。信度估计、收敛效度和发散效度分析表明，该问卷具有良好的内容相关和心理测量特性。为了进一步发展和扩展该工具，使其能够识别病例、严重性和测量病程，形成了本提案。未来的项目分为五个部分。第一阶段将涉及进一步开发SSD-B的完整版本和开发一个简短版本。这些版本将在II期的住院和门诊样本中进行验证。为了扩大SSD-B的潜在用途，将根据最先进的翻译程序创建一个英文版本，然后在英语样本中进行验证（外部项目I）。将在一般人口样本中形成与年龄和性别有关的SSD-B规范（外部项目二）。在最后阶段，该项目的成果将在出版物、地方和国际会议以及保健网络中传播（第三阶段）。SSD-B的完整开发和验证过程的结果有望使躯体症状障碍的更有针对性，更敏感和更早的检测，从而在未来为这些患者提供更实用和与生活质量相关的干预措施。

In May 2013, the American Psychiatric Association published the latest version of the Diagnostic and Statistical Manual of Mental Disorders: DSM-5. This version includes significant improvements in the domain of somatoform type disorders to improve the reliability and clinical utility of the diagnoses. In particular, the new Somatic Symptom Disorder no longer includes the controversial need for organic explicability of symptoms. In contrast, the presence of at least one relevant positive psychological characteristic (B criteria) accompanying the physical symptoms is required: (I) disproportionate and persistent thoughts about the seriousness of one's symptoms, (2) persistently high level of anxiety about health or symptoms, (3) excessive time and energy devoted to these symptoms or health concerns. It is critical to diagnose these patients early to prevent chronification, inappropriate health care use and improve patient care. Although they are no replacement for the gold standard Structured Clinical Interview for DSM-Disorders, self-report questionnaires can be a practical and efficient diagnostic aid. There are scales available to assess physical symptoms (e.g. PHQ-15), however, there is currently no questionnaire to directly assess the new B criteria. The objective of our project is to develop a reliable and valid instrument for this purpose. So far a preliminary version (SSD-B) has been developed and tested on a pilot outpatient psychosomatic sample (n = 156). A confirmatory factor analysis confirmed a three factor structure of a refined 12 item version which was originally formed according to the three sub-criteria. Reliability estimates, convergent and divergent validity analyses suggest that the questionnaire has promising content-related and psychometric properties. In order to further develop and extend the instrument to enable case identification, severity and course measurement, the current proposal was formed. The future project has been divided into five parts. Phase I will involve the further development of the full version of SSD-B and the development of a short version. These versions will be validated in both an in- and out-patient sample in Phase II. To broaden the potential use of SSD-B, an English version will be created according to the state of the art translation procedures and then validated in an English-speaking sample (External Project I). Age- and gender-related norms of SSD-B will be formed in a general population sample (External Project II). In the final phase, the outcomes of the project will be disseminated in publications, at local and international conferences and within health-care networks (Phase III). The outcome of the complete development and validation process of SSD-B will hopefully enable a more targeted, sensitive and earlier detection of somatic symptom disorder so that more pragmatic and quality of life-related interventions can be offered to these patients in the future.