Page 78 - JCBP-2-1

Journal of Clinical and
Basic Psychosomatics Screening for SSD-B criteria in China

increased the AUC–0.921 (P < 0.001). The cutoff value for time in the comparative study was 1.9 h (AUC = 0.801), and the
WI-8 scale score was 11 (AUC = 0.925). Combining the two increased the AUC to 0.935 (P < 0.001). The combination of
time and the WI-8 scale offers a simple, cost-effective, rapid, and direct method for clinical doctors to screen for somatic
symptom disorders–B criteria.

Keywords: Somatic symptom disorder; Psychological criteria; Symptom-related behavior; Reference score; Somatic Symptom
Disorder–B Criteria Scale; Receiver operating curve

1. Introduction self-monitoring as a coping mechanism, undertaking
behaviors such as regular skin inspections, frequent
Many primary care patients complain of physical blood pressure and pulse measurements, and extensive
symptoms not caused by any conventionally defined online research on medical diseases and treatments.
diseases. While most symptoms are mild and self-limiting, The persistence of distressing physical symptoms often
some can be severely disabling and often associated with prompts SSD patients to seek care across different
illness anxiety [1,2] . These patients sought prolonged medical hospitals. In contrast to psychiatric and other mental
attention from different hospitals and departments in an health settings, individuals with SSD are more commonly
attempt to elucidate the cause of the physical symptoms. encountered in primary health care and other medical
These somatic symptoms are frequently referred to as settings, including dermatology, emergency departments,
medically unexplained or functional, causing confusion pediatrics, otolaryngology, and similar fields. Some studies
among patients. Various medical specialties have introduced propose that this prevalence may be linked to a lack of
their own diagnoses for this cohort, such as fibromyalgia SSD diagnosis by non-psychologists or a lack of patients’
in rheumatology, chronic fatigue syndrome in neurology, understanding of the condition [6-9] . From the perspective
and irritable bowel syndrome in gastroenterology. There of etiology, the pathogenesis of SSD remains unclear;
have been evolutions in the diagnostic nomenclature for however, multiple studies underscore the significance
classifying psychiatric disorders, including terms such of psychosocial factors in shaping the distinctive clinical
as “somatization,” “medically unexplained symptoms,” manifestations observed in SSD patients. These factors
and “somatoform disorders,” aiding in the differentiation include negative childhood traumatic experiences,
between mental disorders and psychosomatic diseases. cultural influences, adverse personality foundations,
In 2013, a newly defined disorder known as somatic and life stress events [10-12] . These psychological factors
symptom disorders (SSD) was gazetted in the Diagnostic may drive SSD patients to avoid confronting their inner
and Statistical Manual of Mental Disorders Fifth Edition emotions, manifesting these emotional concerns through
(DSM-5), separating it from the conventional diagnostic physical symptoms. Moreover, these somatic symptoms
definition for somatic symptoms and related disorders. are associated with heightened health-related anxiety and
A major departure from the past lies in the emphasis on catastrophic thinking within this population .
[13]
the importance of “positive” psychological criteria (SSD–B
criteria), indicating that patients exhibit excessive thoughts, While some evidence suggests that positive
feelings, and behaviors that are symptom related . In psychological characteristics can serve as key criteria for
[3]
March 2022, the revised version of DSM-5 (DSM-5-TR), predicting disease progression and improving diagnostic
released by the American Psychiatric Association, retained accuracy when physical complaints are classified as mental
, there remains controversy regarding the
disorders
[14-19]
the original diagnostic criteria. Notably, organic somatic assessment of SSD–B criteria due to the absence of a specific
diseases are no longer used as an exclusionary diagnosis. threshold for quantifying somatic symptoms associated
The current diagnostic criteria incorporate the role of with excessive thoughts, feelings, or behaviors [20,21] . The
psychological factors in disease development of the disease SSD–B Criteria Scale (SSD-12), developed to measure
and exclude the previous psychosomatic dualism disease B-criteria, not only offers clarity but also enables a rapid
attribution model .
[4]
assessment of patients’ psychological burden and behavior
Multiple studies have substantiated that SSD patients related to symptoms [22,23] . The SSD-12 demonstrates high
exhibit suboptimal medical-seeking behavior and internal consistency and favorable item characteristics. In
heightened health anxiety in response to health-related addition, research indicates that the total score of SSD-12 is
symptoms, resulting in a decline in their overall quality significantly higher in patients with chronic diseases (such
of life [1,2,5] . Many of these patients engage in excessive as hypertension and diabetes) compared to those without

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/jcbp.1813