Accuracy of the Clinical Diagnosis of ‘Psychogenic Disorders‘ in the Presence of Physical Symptoms Suggesting a General Medical Condition: A 5-Year Follow-Up in 162 Patients

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Abstract
Objective: The range of unnoticed physical disorders in patients diagnosed with a psychogenic disorder varies widely. We investigated the accuracy of the clinical diagnosis of ‘psychogenic disorder’ where physical symptoms suggesting a somatic condition (PDPS) are present. Method: All 162 cases of PDPS diagnosed between 01.01.1986 and 31.12.1987 in a medical clinic specializing in psychosomatic medicine were reviewed after 5 years. 148 follow-ups were complete. Initial diagnoses had been established using positive criteria for psychogenic diagnosis in a semistructured interview and a comprehensive clinical workup by trained clinicians. Results: In 2 (1.35%) foreign-language patients of 148 an orthopedic diagnosis had been missed. In 6 patients, the family physician gave formerly known findings a different interpretation. Half of these patients were foreigners; 5 were men; none improved; 5 had back pain. Conclusion: A semistructured interview and positive criteria for psychogenic diagnosis permitted high diagnostic accuracy with an error of 1.35% in 148 cases.