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Frontiers in Psychiatry




Frontiers Research Foundation

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This work is licensed under a Creative Commons Attribution 4.0 License.


Persistent somatic symptoms (PSS) are common in all fields of medicine. Current classification systems for mental disorders in this field, i.e. Somatic Symptom Disorder (SSD; DSM-5) or Bodily Distress Disorder (BDD; ICD-11), now stress the relevance of psychological features associated with the physical complaints. It is well known that psychological criteria are among the relevant risk factors for the development and/or worsening of persistent physical symptoms, however, the selected diagnostic criteria remain subject to debate. Numerous psychological concepts have been studied and discussed in the scientific field. However, empirical evidence remains scattered, individual factors have not been reviewed systematically, and longitudinal studies to allow for causal inference are scarce. In our framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSYPSS) (1), we summarized current knowledge regarding psychological variables relevant to the development and maintenance of persistent somatic symptoms (PSS). The framework provides two lists, one of them with 83 relevant symptoms, syndromes and disorders (list 1) and the other with 120 psychological factors, categorized into 42 subcategories and 7 main categories (list 2). Further, we invited other researchers working in the field of PSS to use and also improve our lists by adding terms and constructs which we might have missed in our initial search. Following up on our invitation, Berens and colleagues (2) rightly pointed out that so far, our list of psychological variables did not contain any factors related to personality functioning and mentalizing, although there is scientific evidence for these concepts from the field of PSS, which the authors convincingly explain in their commentary. By adding these important psychodynamic concepts, the authors helped to improve the PSY-PSS framework.