Evolution of Psychosomatic Diagnosis: From Masked Depression to Somatic Symptoms and Related Disorders

Abstract

This paper discusses the history and the concept of somatization from masked depression to somatic symptoms and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Evaluating the evolution of these terms and concepts along the time course is very interesting. DSM 5 revision was intended to increase the relevance of these concepts in the primary care setting. “Masked depression” is a form of depression in which somatic symptoms or behavioral disturbances dominate the clinical picture. Primary care physicians often treat patients who show somatic symptoms without a biological substrate. These patients may receive unnecessary or invasive tests and procedures. An accurate psychiatric screening is essential to diagnose somatic symptoms disorder. As a result, it is very useful to establish a strong therapeutic alliance, and acknowledge and legitimize the patient’s symptoms. Cognitive behavioral therapy, mindfulness-based therapy, and pharmacotherapy are evidence-based therapies. In particular, selective serotonin reuptake inhibitors and tricyclic antidepressants have effectively alleviated somatic symptoms when there is a hidden psychological substrate.