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Criteria for Psychosomatic Research (DCPR) in the Medical Setting

Current Psychiatry Reports volume 12, pages 246–254 (2010)Cite this article

Abstract

The Diagnostic Criteria for Psychosomatic Research (DCPR) represent a diagnostic and conceptual framework that aims to translate psychosocial variables derived from psychosomatic research into operational tools whereby individual patients can be identified. A set of 12 syndromes was developed: disease phobia, thanatophobia, health anxiety, illness denial, persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, anniversary reaction, irritable mood, type A behavior, demoralization, and alexithymia. The aim of this article is to survey the research evidence that has accumulated on the DCPR in several clinical settings (cardiology, oncology, gastroenterology, endocrinology, primary care, consultation psychiatry, nutrition, and community), to examine prevalence and specific diagnostic clusters of the more prevalent DCPR syndromes, and to review their clinical utility in terms of clinical decision, prediction of psychosocial functioning, and treatment outcomes. The implications for classification purposes (DSM-V) are also discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barron J, ed: Making Diagnosis Meaningful: Enhancing Evaluation and Treatment of Psychological Disorders. Washington, DC: American Psychological Association; 1998.

    Book  Google Scholar 

  2. •• Fava GA, Sonino N: Psychosomatic assessment. Psychother Psychosom 2009, 78:333–341. The overall issue of goals and strategies of psychosomatic assessment is carefully explored in this article. The authors make a strong argument for the advantages of the clinimetric methods for the improvement of the clinical process, shared decision making, and self-management and included the DCPR system in the clinimetric framework.

    Article  PubMed  Google Scholar 

  3. Wise TN, Birket-Smith TN: The somatoform disorders for DSM-V: the need for change in process and contents. Psychosomatics 2000, 43:437–440.

    Article  Google Scholar 

  4. Lipowski ZJ :Somatization. Am J Psychiatry 1987, 47:160–167.

    Google Scholar 

  5. Dimsdale J, Creed F: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV-a preliminary report. J Psychosom Res 2009, 66:473–476.

    Article  PubMed  Google Scholar 

  6. Mayou R, Kirmayer LJ, Simon G, et al.: Somatoform disorders: times for a new approach in DSM-V. Am J Psychiatry 2005, 162:847–855.

    Article  PubMed  Google Scholar 

  7. Kissen DM: The significance of syndrome shift and late syndrome association in psychosomatic medicine. J Nerv Ment Dis 1963, 136:34–42.

    CAS  PubMed  Article  Google Scholar 

  8. Fava GA, Freyberger HJ, Bech P, et al.: Diagnostic criteria for use in psychosomatic research. Psychother Psychosom 1995, 63:1–8.

    Article  CAS  PubMed  Google Scholar 

  9. • Sirri L, Fabbri S, Fava GA, Sonino N: New strategies in the assessment of psychological factors affecting medical conditions. J Person Assess 2007, 89:216–228. In this article, the authors review those DCPR clusters that have been found more prevalent in clinical settings, offer suggestions for the use of some independent assessment tools for evaluating DCPR syndromes, and discuss the clinical implications that support the inclusion of the DCPR in the DSM-V.

    Google Scholar 

  10. Pilowsky I: Abnormal Illness Behavior. Chichester, United Kingdom: Wiley; 1997.

    Google Scholar 

  11. •• Porcelli P, Sonino N, eds: Psychological Factors Affecting Medical Conditions. A New Classification for DSM-V. Basel, Switzerland: Karger; 2007. This monograph includes descriptions of each DCPR cluster, an extensive review on validation findings, prevalence data in several medical settings, discussion of clinical implications of the application of DCPR syndromes within the framework of psychological factors affecting medical conditions, and the structured interview for the assessment of DCPR.

    Google Scholar 

  12. Galeazzi GM, Ferrari S, Mackinnon A, Rigatelli M: Interrater reliability, prevalence, and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic Research in consultation-liaison psychiatry patients. Psychosomatics 2004, 45:386–393.

    Article  PubMed  Google Scholar 

  13. • Beresnevaité M, Taykor GJ, Bagby RM: Assessing alexithymia and type A behavior in coronary heart disease patients: a multimethod approach. Psychother Psychosom 2007, 76:186–192. In this study, the diagnostic accuracy of the DCPR syndromes of alexithymia and TAB is evaluated with validated measures (Toronto Alexithymia Scale-20 and Jenkins Activity Survey) as external criteria, showing good to excellent results.

    Article  PubMed  Google Scholar 

  14. Porcelli P, De Carne M: Criterion-related validity of the Diagnostic Criteria for Psychosomatic Research for alexithymia in patients with functional gastrointestinal disorders. Psychother Psychosom 2001, 70:184–188.

    Article  CAS  PubMed  Google Scholar 

  15. Fukunishi I, Hosaka T, Aoki T, et al.: Criterion-related validity of diagnostic criteria for alexithymia in a general hospital psychiatric setting. Psychother Psychosom 1996, 65:82–85.

    Article  CAS  PubMed  Google Scholar 

  16. Mangelli L, Semprini F, Sirri L, et al.: Use of the Diagnostic Criteria for Psychosomatic Research (DCPR) in a community sample. Psychosomatics 2006, 47:143–146.

    Article  PubMed  Google Scholar 

  17. Mattila AK, Saarni SI, Saliminen JK, et al.: Alexithymia and health-related quality of life in a general population. Psychosomatics 2009, 50:59–68.

    Article  PubMed  Google Scholar 

  18. Picardi A, Porcelli P, Pasquini P, et al.: Integration of multiple criteria for psychosomatic assessment of dermatological patients. Psychosomatics 2006, 47:122–128.

    Article  PubMed  Google Scholar 

  19. Fassino S, Abbate Daga G, Pierò A, et al.: Psychological factors affecting eating disorders. In Psychological Factors Affecting Medical Conditions. A New Classification for DSM-V. Edited by Porcelli P, Sonino N. Basel, Switzerland: Karger; 2007:142–168.

  20. Porcelli P, De Carne M, Fava GA: Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychother Psychosom 2000, 69:198–204.

    Article  CAS  PubMed  Google Scholar 

  21. •• Ferrari S, Galeazzi GM, Mackinnon A, Rigatelli M: Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychother Psychosom 2008, 77:306–314. This is the first study evaluating the role played by DCPR in differentiating between high and expected use of health care resources in primary care. The study showed that the DCPR system was useful for identifying subthreshold psychopathology that distinguished patients with high health care use.

    Article  CAS  PubMed  Google Scholar 

  22. Sonino N, Ruini C, Navarrini C, et al.: Psychosocial impairment in patients treated for pituitary disease: a controlled study. Clin Endocrinol (Oxf) 2007, 67:719–726.

    Article  Google Scholar 

  23. •• Porcelli P, Bellomo A, Quartesan R, et al.: Psychosocial functioning in consultation-liaison-psychiatry patients: influence of psychosomatic syndromes, psychopathology and somatization. Psychother Psychosom 2009, 78:352–358. This study showed for the first time the clinical utility of the DCPR system in a population with high psychopathology. In a sample of patients referred to CL psychiatry service, poor psychosocial functioning was independently predicted by DCPR syndromes over and above the contributions of DSM-IV categories and elevated somatic symptom reporting, even after controlling for sociodemographic and medical variables.

    Article  PubMed  Google Scholar 

  24. Grandi S, Fabbri S, Tossani E, et al.: Psychological evaluation after cardiac transplantation: the integration of different criteria. Psychother Psychosom 2001, 70:176–183.

    Article  CAS  PubMed  Google Scholar 

  25. Rafanelli C, Roncuzzi R, Finos L, et al.: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003, 72:343–349.

    Article  PubMed  Google Scholar 

  26. Rafanelli C, Roncuzzi R, Milaneschi Y, et al.: Minor depression as a cardiac risk factor after coronary artery bypass surgery. Psychosomatics 2006, 47:289–295.

    Article  PubMed  Google Scholar 

  27. •• Sirri L, Grandi S, Fava GA: The Illness Attitude Scales. Psychother Psychosom 2008, 77:337–350. This is a comprehensive review of Kellner’s IAS that has been widely used in past years. The IAS is a clinimetric index for the assessment of worry about illness, concerns about pain, health habits, hypochondriacal beliefs, thanatophobia, disease phobia, bodily preoccupations, treatment experience, and effects of symptoms that also constitutes some dimensions of AIB evaluated with the DCPR clusters.

    Article  PubMed  Google Scholar 

  28. Fava GA, Grandi S, Rafanelli C, et al.: Explanatory therapy of hypochondriasis. J Clin Psychiatry 2000, 61:317–322.

    CAS  PubMed  Google Scholar 

  29. Grassi L, Sabato S, Rossi E, et al.: Use of the Diagnostic Criteria for Psychosomatic Research in oncology. Psychother Psychosom 2005, 74:100–107.

    Article  PubMed  Google Scholar 

  30. Maunder RG, Hunter JJ: Attachment and psychosomatic medicine: developmental contributions to stress and disease. Pychosom Med 2001, 63:556–567.

    CAS  Google Scholar 

  31. Kellner R: Psychosomatic syndromes, somatization and somatoform disorders. Psychother Psychosom 1994, 61:4–24.

    Article  CAS  PubMed  Google Scholar 

  32. •• Mangelli L, Bravi A, Fava GA, et al.: Assessing somatization with various diagnostic criteria. Psychosomatics 2009, 50:38–41. In a large group of patients with functional somatic symptoms and recent first myocardial infarction, this study showed that the DCPR clusters of AIB and somatization identified clinical and subthreshold psychosomatic syndromes. The two DCPR clusters had a ratio 2 to 2.75 times greater than the DSM-IV diagnoses included in the rubric of somatoform disorders.

    Article  PubMed  Google Scholar 

  33. Frank JD: Psychotherapy: the restoration of morale. Am J Psychiatry 1974, 131:271–274.

    CAS  PubMed  Google Scholar 

  34. Cockram CA, Doros G, de Figueiredo JM: Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychother Psychosom 2009, 78:342–345.

    Article  PubMed  Google Scholar 

  35. Clarke DM, Kissane DW: Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 2002, 36:733–742.

    Article  PubMed  Google Scholar 

  36. Mangelli L, Fava GA, Grandi S, et al.: Assessing demoralization and depression in the setting of medical disease. J Clin Psychiatry 2005, 66:391–394.

    Article  PubMed  Google Scholar 

  37. Porcelli P, De Carne M: Non-fearful panic disorder in gastroenterology. Psychosomatics 2008, 49:543–545.

    Article  PubMed  Google Scholar 

  38. Snaith RP, Taylor CM: Irritability. Br J Psychiatry 1985, 147:127–136.

    Article  CAS  PubMed  Google Scholar 

  39. Mangelli L, Fava GA, Grassi L, et al.: Irritable mood in Italian patients with medical disease. J Nerv Ment Dis 2006, 194:226–228.

    Article  PubMed  Google Scholar 

  40. Friedman M, Rosenman RH: Type A Behavior and Your Heart. New York: Knopf; 1974.

    Google Scholar 

  41. Bagby RM, Taylor GJ, Parker JD, Doclems SE: The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom 2006, 75:25–39.

    Article  PubMed  Google Scholar 

  42. • Grassi L, Mangelli L, Fava GA, et al.: Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V. J Affect Disord 2007, 101:251–254. Using a large sample of medical patients, this study showed that the wide DSM-IV category of adjustment disorders may be considered a cover for multiple DCPR syndromes, such as AIB, somatization, and demoralization.

    Article  PubMed  Google Scholar 

  43. Ryff CD, Dienberg Love G, Urry HL, et al.: Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychother Psychosom 2006, 75:85–95.

    Article  PubMed  Google Scholar 

  44. Picardi A, Pasquini P, Abeni D, et al.: Psychosomatic assessment of skin diseases in clinical practice. Psychother Psychosom 2005, 74:315–322.

    Article  PubMed  Google Scholar 

  45. Grassi L, Rossi, E, Sabato S, et al.: Diagnostic Criteria for Psychosomatic Research and psychosocial variables in breast cancer patients. Psychosomatics 2004, 45:483–491.

    Article  PubMed  Google Scholar 

  46. Sonino N, Navarrini C, Ruini C, et al.: Persistent psychological distress in patients treated for endocrine disease. Psychother Psychosom 2004, 73:78–83.

    Article  PubMed  Google Scholar 

  47. Ottolini F, Modena MG, Rigatelli M: Prodromal symptoms in myocardial infarction. Psychother Psychosom 2005, 74:323–327.

    Article  PubMed  Google Scholar 

  48. Porcelli P, De Carne M, Todarello O: Prediction of treatment outcome of patients with functional gastrointestinal disorders by the Diagnostic Criteria for Psychosomatic Research. Psychother Psychosom 2004, 73:166–173.

    Article  PubMed  Google Scholar 

  49. • Fava GA, Wise TN: Psychological factors affecting either identified or feared medical conditions: a solution for somatoform disorders. Am J Psychiatry 2007, 164:1002–1003. This editorial focused on the theoretical and clinical challenges that should be faced in the diagnosis of psychosomatic conditions in the DSM-V. The authors introduced their view about the utility of including hypochondriasis and six DCPR syndromes as part of the next edition of the DSM.

    Article  PubMed  Google Scholar 

  50. • Wise TN: Diagnostic Criteria for Psychosomatic Research are necessary for DSM V. Psychother Psychosom 2009, 78:330–332. In this editorial, the author discusses the clinical implications of the DCPR and supports its inclusion in the DSM-V.

    Article  PubMed  Google Scholar 

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Author information

Affiliations

  1. Psychosomatic Unit, IRCCS De Bellis Hospital, Via Turi 27, 70010, Castellana Grotte, Bari, Italy

    Piero Porcelli

  2. Department of Psychology, University of Bologna, Viale Berti Pichat 5, Bologna, 40127, Italy

    Chiara Rafanelli

Authors
  1. Piero Porcelli
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  2. Chiara Rafanelli
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Correspondence to Piero Porcelli.

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Porcelli, P., Rafanelli, C. Criteria for Psychosomatic Research (DCPR) in the Medical Setting. Curr Psychiatry Rep 12, 246–254 (2010). https://doi.org/10.1007/s11920-010-0104-z

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  • DOI: https://doi.org/10.1007/s11920-010-0104-z

Keywords

  • Abnormal illness behavior
  • Alexithymia
  • Demoralization
  • Diagnostic criteria for psychosomatic research
  • Health anxiety
  • Somatization
  • Type A behavior