Primary care physicians are trained to recognize a client’s physical symptoms and determine the physiological or biological cause of those symptoms. But too often, clients visit their primary care physicians with physical symptoms that are psychological in origin. Depression and anxiety, two of the most frequently occurring mental health problems, have symptoms that can overlap, such as negative affect and internalizing behaviors. To better identify which specific mental health problems may be causing physical symptoms, L.J. Simms of the University at Buffalo of the State University of New York analyzed specific models that are used to identify somatic symptoms of depression and anxiety. Some experts believe that all mood disorders, including generalized anxiety, major depression, obsessive-compulsive disorder, posttraumatic stress, and social phobias, should be lumped together in one classification of “emotional disorders” in the upcoming revised DSM-V. However, others believe there is a clear distinction between the somatic symptoms of each of these illnesses.
To clarify how these symptoms vary, Simms examined data from 5,438 clients who were part of the World Health Organization’s Collaborative Study of Psychological Problems in General Health Care. The participants included clients from 14 countries and were assessed using the Primary Care Version of the Composite International Diagnostic Interview (CIDI-PC). The results revealed that the participants with depression exhibited unique symptoms that were different than those evident in participants with anxiety. Although negative affect was present in most of the participants with depression and anxiety, those with somatic symptoms had the highest levels of internalizing, followed closely by those with depression. These findings suggest that there is a difference in how physical symptoms manifest in each of these illnesses. Simms said, “In addition, diagnostic methods are needed (e.g. computerized scoring and/or administration of measures) that permit efficient parsing of such common and unique elements in clinical settings.” But until those measures are designed, Simms believes that primary care physicians who treat individuals presenting with physical symptoms and generalized negative affect should rely on existing models to determine whether or not there are underlying psychological causes.
Simms, L. J., Prisciandaro, J. J., Kreuger, R. F., Goldberg, D. P. The Structure of Depression, Anxiety and Somatic Symptoms in Primary Care. Psychological Medicine 42.1 (2012): 15-28. Print.
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