The integrated diagnoses can be categorized into three classes: somatic symptoms, demoralization and stress, and insomnia. Credit: National Taiwan University

Although psychosomatic medicine is regarded as a branch of psychiatry in many countries, some of its diagnostic concepts are not fully encompassed by mainstream psychiatric diagnostic systems. When these two systems are integrated, the interrelationships among various diagnoses and their associations with psychopathologies remain to be elucidated.

One of the most widely used contemporary psychiatric diagnostic systems is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, DSM-5 does not encompass all the key concepts in the field of psychosomatic medicine.

To address the limitations of the DSM system, a diagnostic framework known as the Diagnostic Criteria for Psychosomatic Research (DCPR) was developed in the 1990s. It includes several classic psychosomatic concepts, such as type A behavior and alexithymia. The Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) is its new version.

In a study published in Psychotherapy and Psychosomatics, researchers from National Taiwan University used a standardized interview to comprehensively examine the relationships between DCPR-R and various DSM-5 diagnostic constructs in 502 individuals.

They focused on three core questions:

The results showed that DCPR-R/DSM-5 diagnoses could be grouped into three main classes based on latent class analysis: somatic symptoms, demoralization and stress, and insomnia.

In addition, somatic symptoms could be further distinguished between constructs related to short-term stress (such as health anxiety) and those representing more chronic and persistent concepts (such as somatic symptom disorder, persistent somatization, hypochondriasis, and disease phobia).

In terms of psychopathological phenomena, the diagnoses most strongly associated with somatic distress were persistent somatization, major depressive disorder, generalized anxiety disorder, adjustment disorder, and panic disorder.

The diagnosis most strongly associated with illness-related anxiety was somatic symptom disorder. The diagnoses most strongly associated with depression were major depressive disorder, generalized anxiety disorder, adjustment disorder, and irritable mood.

When focusing on overall quality of life, the DSM-5 diagnoses remained the most impactful, particularly major depressive disorder, generalized anxiety disorder, and adjustment disorder. Among the DCPR-R diagnoses, those with relatively stronger associations with quality of life were irritable mood and demoralization with hopelessness.

The study also yielded several interesting findings. For example, when focusing on quality of life, DSM-5 remains a highly reliable and broadly influential system; thus, clinical decisions based on DSM-5 diagnoses are likely to be highly efficient.

However, incorporating DCPR-R concepts offers opportunities to add more individualized meaning in nuanced areas. In addition, adjustment disorder was among the top diagnoses in terms of associations with both psychopathology and quality of life, suggesting that issues related to short-term stress, even when not meeting the full criteria for major depressive disorder or generalized anxiety disorder, can still involve considerable distress.

In the DCPR-R framework, the constructs within the "demoralization and stress" class—such as demoralization, demoralization with hopelessness, irritable mood, and Type A behavior—were those that most substantially affected quality of life.

In contrast, the diagnoses within the "somatic symptoms" class had relatively modest impacts.

"We hope that the results of this study will contribute to the further development of diagnostic systems and help guide the design of more personalized treatment plans, " says Prof. Wei-Lieh Huang.

More information: Wei-Lieh Huang et al, Integrating DCPR-R and DSM-5 into clinical psychosomatic practice in Taiwan: Their relationship with psychopathologies and quality of life, Psychotherapy and Psychosomatics (2025). DOI: 10.1159/000545409  Journal information: Psychotherapy and Psychosomatics