New Concepts of Psychosomatic Disorders and Their Significance for a Health Care System

抄録

Physicians from many medical societies within the Japanese Society of Psychosomatic Medicine (internal medicine, gynaecology, dentistry, and anaesthesiology) have questioned how to appropriately diagnose psychosomatic patients in these different disciplines, and how to then determine the varied therapeutic response each patient may need. Another question of importance is whether individual disciplines require their own personalized systems of psychosomatic diagnosis or a common psychosomatic diagnostic system designed by an individual discipline may work for all other disciplines. Considering the latter, what does it then mean when a discipline such as psychiatry has the sole authority to present definitions for psychosomatic disorders in all disciplines depending on the quality of studies that have been published in that field over the last five to ten years? I will endeavour to discuss with you the redefinition of new concepts of psychosomatic disorders in Japan and call attention to the complications arising from the diagnoses of “bodily distress disorder/somatic symptom disorder”, “functional disorders”, “physical diseases with a psychosocial cause”, “depression” or “anxiety”, which exacerbate the course of physical disease via psychosocial triggers. From a psychosomatic viewpoint, we can describe these disorders as a psychiatric mind or neurological brain dysfunction, or a complex mind-brain-body interaction, including an internal medicine perspective, as has been demonstrated in irritable bowel syndrome (IBS). I reject the idea of the predominant view of psychiatry, neurology, sociology, and internal medicine in order to understand and treat these disorders. High-level international scientific representatives for classification systems (ICD-11, DSM-5), patients, society, and the country’s health system must decide on this important issue of psychosomatic disorders.