International Journal of Behavioral Medicine

, Volume 23, Issue 5, pp 580–588 | Cite as

Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic

  • Mutsuhiro NakaoEmail author
  • Takeaki Takeuchi



The definition of psychosomatic medicine is not consistent across countries.


The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital.


The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other.


In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p < 0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p < 0.05).


Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.


Anxiety Consultation–liaison psychiatry Depression Japan Psychosomatic medicine 



We thank the staff in the Department of Psychosomatic Medicine, Teikyo University Hospital for data collection.

Compliance with Ethical Standards

Conflict of Interests

All procedures were consistent with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients included in the study. The first author, Mutsuhiro Nakao, has no conflict of interests. The second author, Takeaki Takeuchi, has no conflict of interests.


  1. 1.
    Leentjens AF, Rundell JR, Wolcott DL, Guthrie E, Kathol R, Diefenbacher A. Reprint of: Psychosomatic medicine and consultation–liaison psychiatry: scope of practice, processes, and competencies for psychiatrists working in the field of CL psychiatry or psychosomatics. A consensus statement of the European Association of Consultation–Liaison Psychiatry and Psychosomatics (EACLPP) and the Academy of Psychosomatic Medicine (APM). J Psychosom Res. 2011;70:486–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Fava GA, Belaise C, Sonino N. Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry. Curr Psychiatry Rep. 2010;12:215–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64:1155–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Sirri L, Fava GA. Diagnostic criteria for psychosomatic research and somatic symptom disorders. Int Rev Psychiatry. 2013;25:19–30.CrossRefPubMedGoogle Scholar
  5. 5.
    The Committee on Education and Training of the Japanese Society of Psychosomatic Medicine. An updated treatment guideline for psychosomatic medicine. Jpn J Psychosom Med. 1991;31:537–76 [in Japanese].Google Scholar
  6. 6.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington D.C: American Psychiatric Press; 2000.CrossRefGoogle Scholar
  7. 7.
    Nakao M, Nomura S, Yamanaka G, Kumano H, Kuboki T. Assessment of patients by DSM-III-R and DSM-IV in a Japanese psychosomatic clinic. Psychother Psychosom. 1998;67:43–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999;130:910–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet. 2007;369:946–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Huyse FJ, Herzog T, Lobo A, Malt UF, Opmeer BC, Stein B, et al. European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study. Psychosomatics. 2000;41:330–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Deter HC. Psychosomatic medicine and psychotherapy: on the historical development of a special field in Germany. Adv Psychosom Med. 2004;26:181–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Novák M, Gazdag G, Túry F. Psychosomatic medicine and consultation–liaison psychiatry in Hungary. J Psychosom Res. 2009;66:187–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Nakao M, Takeuchi T, Yano E. Prescription of benzodiazepine in comparison with SSRI and SNRI for outpatients attending a Japanese university hospital. Int J Clin Pharmacol Ther. 2007;45:30–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Nakao M, Takeuchi T, Fricchione GL. Definition of psychosomatic medicine and the applicability of DSM-IV-TR to outpatients visiting a Japanese psychosomatic clinic. Psychother Psychosom. 2014;83:120–1.CrossRefPubMedGoogle Scholar
  15. 15.
    First MB, Spitzer RL, Gibbon M, Williams JBW. The structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington D.C.: American Psychiatric Publishing, Inc; 1997.Google Scholar
  16. 16.
    Nakao M, Kumano H, Nomura S, Kuboki T, Yokoyama K, Murata K. Fatigue mood as a discriminating indicator between anorexia nervosa and bulimia nervosa. Acta Psychiatr Scand. 1998;97:202–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Nakao M, Kumano H, Nomura S, Kuboki T, Murata K. Assessment of ego state in anorexia nervosa and bulimia nervosa. Acta Psychiatr Scand. 1999;99:385–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Fairburn CG, Harrison PJ. Eating disorders. Lancet. 2003;361:407–16.CrossRefPubMedGoogle Scholar
  19. 19.
    Cheng SK, Dizon J. Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychother Psychosom. 2012;81:206–16.CrossRefPubMedGoogle Scholar
  20. 20.
    Morin CM, Benca R. Chronic insomnia. Lancet. 2012;379:1129–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, de Gruy 3rd FV, et al. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994;3:774–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Kroenke K, Spitzer RL. Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med. 1998;60:150–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Nakao M, Fricchione G, Myers P, Zuttermeister PC, Baim M, Mandle CL, et al. Anxiety is a good indicator for somatic symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic. Psychother Psychosom. 2001;70:50–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Nakao M, Myers P, Fricchione G, Zuttermeister PC, Barsky AJ, Benson H. Somatization and symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic. Behav Med. 2001;26:169–76.CrossRefPubMedGoogle Scholar
  25. 25.
    Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res. 1990;24:323–34.CrossRefPubMedGoogle Scholar
  26. 26.
    Nakao M, Kumano H, Kuboki T, Barsky AJ. Reliability and validity of the Japanese version of Somatosensory Amplification Scale: clinical application to psychosomatic illness. Jpn J Psychosom Med. 2001;41:539–47 [in Japanese].Google Scholar
  27. 27.
    Nakao M, Barsky AJ, Kumano H, Kuboki T. Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic. Psychosomatics. 2002;43:55–60.CrossRefPubMedGoogle Scholar
  28. 28.
    McNair DM, Lorr M, Droppleman LF. Profile of mood states. Educational and industrial testing service. San Diego; 1971.Google Scholar
  29. 29.
    Yokoyama K, Araki S, Kawakami N, Takeshita T. Production of the Japanese edition of Profile of Mood State (POMS): assessment of reliability and validity. Jpn J Public Health. 1990;37:913–8 [in Japanese].Google Scholar
  30. 30.
    Nakao M, Shinozaki Y, Ahern DK, Barsky AJ. Anxiety as a predictor of improvements in somatic symptoms and health anxiety associated with cognitive–behavioral intervention in hypochondriasis. Psychother Psychosom. 2011;80:151–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Nakao M, Yamanaka G, Kuboki T. Major depression and somatic symptoms in a mind/body medicine clinic. Psychopathology. 2001;34:230–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Nakao M, Yano E. Prediction of major depression in Japanese adults: somatic manifestation of depression in annual health examinations. J Affect Disord. 2006;90:29–35.CrossRefPubMedGoogle Scholar
  33. 33.
    Ostergaard SD, Petrides G, Dinesen PT, Skadhede S, Bech P, Munk-Jørgensen P, et al. The association between physical morbidity and subtypes of severe depression. Psychother Psychosom. 2013;82:45–52.CrossRefPubMedGoogle Scholar
  34. 34.
    Gerrits MM, van Oppen P, van Marwijk HW, van der Horst H, Penninx BW. The impact of chronic somatic diseases on the course of depressive and anxiety disorders. Psychother Psychosom. 2013;82:64–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Fava GA, Trombini G, Grandi S, Bernardi M, Canestrari R. A psychosomatic outpatient clinic. Int J Psychiatry Med. 1987;17:261–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Wollburg E, Voigt K, Braukhaus C, Herzog A, Löwe B. Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5. J Psychosom Res. 2013;74:18–24.CrossRefPubMedGoogle Scholar
  37. 37.
    Voigt K, Wollburg E, Weinmann N, Herzog A, Meyer B, Langs G, et al. Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder: comparison with DSM-IV somatoform disorders and additional criteria for consideration. J Psychosom Res. 2012;73:345–50.CrossRefPubMedGoogle Scholar
  38. 38.
    Sharma MP, Manjula M. Behavioural and psychological management of somatic symptom disorders: an overview. Int Rev Psychiatry. 2013;25:116–24.CrossRefPubMedGoogle Scholar
  39. 39.
    Rundell JR, Amundsen K, Rummans TL, Tennen G. Toward defining the scope of psychosomatic medicine practice: psychosomatic medicine in an outpatient, tertiary-care practice setting. Psychosomatics. 2008;49:487–93.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  1. 1.Department of Psychosomatic MedicineTeikyo University HospitalItabashiJapan

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