From hysteria to somatic symptom disorders: searching for a common psychopathological ground.

After decades of manifold contributions aimed at defining hysteria, somatisation and conversion, such syndromes are still neglected and their nosographical definition is debated. The DSM and the ICD had underwent major changes, but their clinical utility with regard to these syndromes is still questionable. On the contrary, the Diagnostic Criteria for Psychosomatic Research represent a useful clinical instrument since they translated psychosocial variables derived from psychosomatic research into operational tools. The present paper offers an overview on the psychopathological description of syndromes such as alexithymia, hypochondriasis, health anxiety, thanatophobia, conversion symptoms, anniversary, reaction which are frequent in clinical practice but often misdiagnosed due to their absence in the DSM and the ICD. In addition, the influence of culture and cultural changes on the modifications of psychopathological manifestations is described as a further possible source of misdiagnosing and underreporting. New psychopathologies (e.g., multiple chemical sensitivity, orthorexia/vigorexia) that resemble conversion and/or somatization have been developed, but neither included in the nosography nor taught to clinicians. The aim of the present paper is thus to describe psychopathological manifestations of somatic symptoms and related disorders to help clinicians formulate their diagnosis on the basis of the presence of signs and symptoms that can be elicited during a clinical visit, rather than by way of excluding any other organic or psychiatric disease only.