신체화장애 진단기준의 변형을 위한 예비적 연구 ᅳ신체형장애의 임상적 적용을 위 한 연구(ll) ㅡ
A Preliminary Study for Modification of Diagnostic Criteria of Somatization Disorder ㅡFor the Clinical Application of Somatoform Disorder in Korea(ll) —
This study was designed as a preliminary one for modification of possible Korean diagnostic criteria of somatization disorder(SD). As the first step of this study the authors tested the hypothesis that somatic symptoms of SD in Korea are different from those of DSM-III diagnostic criteria. The authors made revised DSM-III diagnostic criteria of SD that include those 12 culture bound symptoms derived 21 symptom item pools which we consider are characteristics of somatic symptoms of Korean neurotic patients and which showed statistically significant difference in positive response rate between SD and non-SD patient group in our study. Diagnostic assessments of 265 adult neurotic out-patients were made according to four criteria, original (DSM-III) definite, revised definite, original probable, and revised probable criteria. Distinction of definite from probable was based on the severity of each somatic symptom. It was found that diagnostic agreement (expressed as K value) of SD increased considerably to the point of K=0.92 and 0.89 by the use of revised probable and revised definite criteria respectively. Diagnostic agreement was only K=0.66 by the original (DSM-III) definite criteria. And the revised definite was best correlated with original definite criteria ( r = 0.9335). The authors could also identify the optimum number of positive somatic symptom by the use of revised definite criteria in SD patient group (mean number = 16.4). These results suggests that the revised definite criteria can be more reliable and adequately applied to the diagnosis of SD in Korea, keeping consistency with the concept of DSM-III SD. They also reflect that the symptoms of SD in Korea are different from those of DSM-III. The authors examined the concurrent neurotic disorders(other than SD) of SD and calculated odds ratios for each concurrent neurotic disorders to verify DSM-III exclusion criteria. The results are as follows * 1) Presence of SD increased the risk of coexistence of other neurotic disorders, especially panic disorder and major depression. 2) The symptoms of SD were best correlated with those of major depression ( r = 0.3476). These findings suggest that the features of SD occur in other neurotic disorders, and that SD is a diagnostic categrory which cannot be easily differentiated from other neurotic disorders. Further investigation to test the practical basis of DSM-III exclusion criteria of SD will be necessary.
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