Skip to main content Accessibility help

Somatisation disorder in primary care

  • Javier I. Escobar (a1), Michael Gara (a1), Roxanne Cohen Silver (a2), Howard Waitzkin (a3), Alison Holman (a4) and Wilson Compton (a5)...



Somatisation is a common and frustrating clinical problem in primary care.


Using structural diagnoses and functional measures, we examined the prevalence and associated features of somatisation disorder defined by three current nosologies and an abridged construct in subjects using primary care services.


Somatisation disorder, diagnosed according to the standard criteria, was found to have a very low prevalence (range 0.06–5%), while more than one-fifth of the sample (22%) met the criteria for the abridged diagnosis. There was poor agreement between succeeding versions of the DSM system for identifying cases of somatisation disorder, each system ending up with rather disparate sets of individuals as well as variable levels of psychopathology and disability.


According to these data, standard somatisation disorder diagnoses add little to the prediction of disability/psychopathology beyond the contributions of an abridged construct of somatisation.


Corresponding author

Javier I. Escobar, Department of Psychiatry. UMDNJ – Robert Wood Johnson Medical School, 675 Hoes Lane. Piscataway, NJ 08854–5635, USA


Hide All
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.
Brook, R. H. (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Brook, R. H. (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Brook, R. H. Ware, J. E. Stewart, A. L. et al (1979) Conceptualization and Measurement of Health for Adults in the Health Insurance Study, Volume VII. Santa Monica, CA: and Corporation.
Escobar, J. I. (1997) Developing practical indexes of somatization in primary care. Journal of Psychosomatic Research, 42, 323328.
Escobar, J. I. Burnam, M. A. Karno, M. et al (1987) Somatization in the community. Archives of General Psychiatry, 44, 713719.
Escobar, J. I. Manu, P. Lane, T. et al (1989 a) Medically unexplained physical symptoms, somatization disorder and abridged somatization: studies with the diagnostic interview schedule. Psychiatric Developments, 3, 235245.
Escobar, J. I. Rubio, M. Canino, G. et al (1989 b) Somatic Symptom Index (SSI): A new and abridged somatization construct: Prevalence and epidemiological correlates in two large community samples. Journal of Nervous and Mental Disease, 177, 140146.
Feighner, J. P. Robins, E. Guze, S. B. et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.
Goldberg, D. P. & Bridges, K. (1988) Somatic presentation of psychiatric illnesses in primary care settings. Journal of Psychosomatic Research, 30, 137144.
Goodwin, D. W. & Guze, S. B. (1994) Psychiatric Diagnosis. New York: Oxford University Press.
Gureje, O. Simon, G. E. Ustun, T. B. et al (1997) Somatization in cross-cultural perspective: A World Health Organization study in primary care. American Journal of Psychiatry, 154, 989995.
Katon, W. Lin, E. & Von Korff, M. (1991) Somatization: A spectrum of severity. American Journal of Psychiatry, 148, 3440.
Purtell, J. J. Robins, E. & Cohen, M. E. (1951) Observations on clinical aspects of hysteria. Journal of the American Medical Association, 146, 902909.
Rief, W. Heuser, J. Mayrhuber, E. et al (1996) The classification of multiple somatoform symptoms. Journal of Nervous and Mental Disease, 184, 680687.
Robins, L. N. Wing, J. Wittchen, H. U. et al (1988) The Composite International Diagnostic Interview. Archives of General Psychiatry, 45, 10691077.
Smith, G. R. (1990) Somatization Disorders in the Medical Setting, DHHS publication No. (Adm) 90–1631. Washington, DC: US Government Printing Office.
Smith, G. R. Rost, K. & Keshner, M. (1995) A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry, 52, 238243.
Sullivan, M. Clerk, M. R. & Katon, W. J. (1993) Psychiatric and otologic diagnoses in patients complaining of dizziness. Archives of Internal Medicine, 153, 14791484.
Swartz, M. Landerman, R. George, L. et al (1990) Somatization disorder. In Psychiatric Disorders in America. (eds Reiger, D. A. & Robins, L. N.), pp. 220257. New York: Free Press.
World Health Organization (1990) ICD–10 Chapter V, Mental and Behavioral Disorders–Diagnostic Criteria for Research. Geneva: WHO.
Swartz, M. (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.
Yutzi, S. H. Cloinger, R. C. Guze, S. B. et al (1995) DSM–IV field trial: testing a new proposal for somatization disorder. American Journal of Psychiatry 152, 97101.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Somatisation disorder in primary care

  • Javier I. Escobar (a1), Michael Gara (a1), Roxanne Cohen Silver (a2), Howard Waitzkin (a3), Alison Holman (a4) and Wilson Compton (a5)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *