Although psychiatric measures are needed to better define this high-use population, their absence in this initial study does not negate the importance of our findings from medical patients’ charts. They presumably reflect what patients actually reported to providers as their major reasons for seeking care, in contrast to questionnaire and lay interviewer data obtained unrelated to care seeking. Complementing our chart-based data with these standard psychiatric measures is the necessary next step.
Others have considered the problem of minor symptoms. Barsky and Borus7 seemed to distinguish short-term symptoms from the chronic symptoms of somatization and somatoform disorders by including many symptoms that often are brief and self-limited in what they called functional somatic syndromes (eg, palpitations, dizziness, lightheadedness, sore throat, and dry mouth). To avoid compounding the severe nosology problem in somatization24,25 and because the term functional somatic syndromes has been used by others to encompass all types of somatization,26,27 we are using the purely descriptive term “minor acute illness” to identify the patients reported here with short-term symptoms, recognizing that there may be considerable overlap with the group of patients identified by Barsky and Borus,7 Katon and colleagues,28 the acute and subacute somatizers of Kleinman,8 and the somatoform “not otherwise specified” category in DSM-IV.29 We prefer minor acute illness also to the common but pejorative term “worried well,” which we believe has never been defined. The “minor acute” label also has been used previously in a closely related context.30 Similar to Katon and coworkers,28 we propose that minor acute illness fits into the mild end of a multidimensional classification scheme for patients with medically unexplained symptoms—with abridged somatization disorder31 as moderate and full somatization disorder as severe.3 The latter 2 diagnoses are based on DSM-IV criteria only.
CONCLUSIONS
More research is needed to assist the field in better addressing patients with medically unexplained symptoms. The long-range goal for minor acute illness (as well as somatization) is to determine if it is a distinct and valid entity. In what is a complex task for psychiatric epidemiologists in the absence of organic disease and pathophysiologic changes,32-37 we can use the recommendations of Guze and colleagues38,39 for establishing the validity of a psychiatric diagnosis to guide us (Table 2). At this point, we can say only that there is evidence from our initial research study that we can use to describe and define minor acute illness and that it persists over 2 years (criteria 1 and 4 from Table 2). These are key determinants of validity, but they require much confirmation.38,39 Extensive work lies ahead in achieving our ultimate goal, providing effective treatment for a group that often receives inappropriate treatment, such as unnecessary antibiotics.
TABLE 2
VALIDITY CRITERIA FOR PSYCHIATRIC ENTITIES
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| NOTE: From Guze and colleagues,38,39 who comment that we often know little about criteria 2 and 3, and a careful description must focus on criteria 4 and 5, follow-up studies, and family studies. |
Acknowledgments
Our work was supported by a generous grant from the Institute for Managed Care, Michigan State University, East Lansing.