In DSMIII (the third edition of the Diagnostic and Statisitical Manual of Mental Disorders of APA 1980) there Is a new cllnrcal entrty named "Somatoform Drsorders" According to this manual rt Is defined" the essentral features of this group of drsorders are physical symptoms suggesting physical disorder (hence, Somatoform) for which there are no demonstrable organic findings or known physiological mechanisms and for which there is positive evidence, or a strong presumption, that the symptoms are linked to psychological factors or confiicts."Most doctors, who deal with psychosomatic disorders in Japan, must be paying attention on this new clinical entity, because there is some description concerning these situations in the " Therapeutic Manual of Psychosomatic Disorders" (by the Japanese Society of Psychosomatic Medicme 1970) as follows "Some cases whrch can be dragno ed as neuros s although they have mamly physrcal manrfestations, should be treated the same way as psychosomatic disorders in a wider sense." These Somatoform Disorders are classified into five subtypes as follows ; (1) Somatization disorder (Briquet's disease), (2) Conversion disorder (hysterical neurosis), (3) Psychogenic pain disorder, (4) Hypochondriasis (hypochondriacal neurosis), (5) Atypical disorder (dysmorphic disorder). Moreover, some other relevant concepts concerning "hypochondriacal neurosis, " such as c6nestopathie, hypochondriacal delusion and kdrperliches Beeinflussungsgefthl (K. Schneider) are also introduced and discussed in this paper.

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Psychosomatics are originally physical illnesses in which some psychological factors have participated in the course of those illnesses from the onset. On the other hand, somatoform disorders as defined in DSMIII could be understood as physically manifested neuroses. Therefore, the somatoform disorder has a process by which the body is used for a psychological purpose or for personal gain. PSD has a disturbed somatic function by which an unstable self-supportiveness has raised a chronic tension since his early childhood, We have found that distribution rates of mental disorders by DIS diagnosis (NIMH Diagnostic Interview Schedule) are 30-60% in physical patients in three hospitals. And so-called psychosomatic patients, such as diabetes mellitus, bronchial asthma and hypertension, have fewer mental disorders. I believe that the PSD patient has a defect in manifestation capacity of psychic symptom. Symptomformations in PSD are influenced by these special characteristics of the patient's personality. Therefore, we should consider some differences of psychodynamics between both disorders in their treatment.

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l) Fiftyfive outpatients complaining of faicial pain were investigated from the clinical view point of psychosomatic disease and somatoform disorder. 2) Some differences between organic pain and nonorganic pain (somatoform disorder) were noted especially in the location of pain, characteristics of pain, personality traits, predisposing factors, existence of chronically stressful situation and practical treatment. 3) Among somatoform disorders (somatization disorder, conversion disorder, psychogenic pain disorder, hypochondriasis and atypical somatoform disorder), psychogenic pain disorder was most closely related to organic pain in terms of age, sex, Iocation and characteristics of pain. But it differed from organic pain in personality traits and existence of the psychological factors. Thus, it was suggested that psychogenic pain disorder had more of factors of psychosomatic disease. 4) For the diagnosis and therapy of patients complaining of pain, we need multidimensional (somato-psycho-socio-ecological) approaches which are based on the anthropological points of view. DSMIII is useful for this purpose, which means that we need the view of ps chosomatic medicine.

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Statistical studies on psychosomatic diseases and somatoform disorders in outpatients in a psychosomatic clinic of Tokyo University Hospital were performed. Subjects were 179 outpatients who visited Dr. Sogo from 1982 to 1984. Table I shows the classification of patients who were diagnosed with DSM-III criteria. As a typical psychosomatic disease, patients with " psychological factors affecting physical condition " numbered 69. As somatoform dlsorders patlents of "somatlzatron disorder " numbered 12 (7%), " conversron drsorder" 6 (3%), " psychosomatic pain" 8 (5%), " hypochondrlasls" 14 (9%), and " atypical somatoform disorder" 3 (2%). The total number of somatoform disorders patients numbered 43 (24%), about 1/4 of the 179 outpatients studied. Differences were found between the DSM-III diagnosis and the diagnosis of the psychosomatic clinic. For example, patients with "somatoform disorders " were diagnosed as " vegetative labile syndrome, " "climacteric disorder, " or " irritable bowel syndrome." Patients with " conversion disorder " were diagnosed as " headache " or "left abdominal pain." Patients with " hypochondnasrs " were dlagnosed " cardrac neurosls" or " chronlc gastntis." These differences were due to the fact that the axis I-diagnosis of DSM-III is based on psychiatric symptomatology while the diagnosis in the psychosomatic clinic, which resembled the axis nl diagnosis of DSMm, is based on somatic symptomatology. Several of these cases are reported. One patient, a 23-year old female, diagnosed as " vegetative labile syndrome " in the psychosomatic clinic, complained of 16 symptoms including abdominal pain, diarrhea, back pain, palpitation and dizziness. Using the DSM-III criteria, she was diagnosed as " somatoform disorders." A 66-year old female, diagnosed as " neck pam " In the psychosomatlc climc was dragnosed as " psychogenrc paln " vath DSM-III cntena as she had no organic damage, and the psychological cause of the pain was clear. As the egogram of patients with psychogenic pain resembled that of hysterical patients, psychogenic pain may be related in some way with hysteria. A 59-year old male visited our clinic for over 17 years complaining of a fear of heart attack. His diagnosis in the psychosomatic clinic was " cardiac neurosis, " but according to DSM=III criteria, because his fear was too strong and without any physical abnormality, he was rediagnosed as " hypochondriasis." Table 2 shows the comparison of patients between the psychiatric clinic and the psychosomatic clinic. In the psychiatric clinic, many patients were observed with "affective disorders " or " schizophrenic disorder." In the psychosomatic clinic, patients with " psychological factors affecting physical condition " were in the majority. In the psychiatric clinic, 100% of patients were found to have " somatoform disorders " in comparison to 24% in the psychosomatic clinic. DSM=III is very useful in understanding patients from a wholistic standpoint.

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In the field of psychosomatic medicine, there are many cases where patients enter the hospital with somatized symptoms as well as psychosomatic diseases. Among them, there exist cases which are diagnosed as somatoform disorders based on the DSM-III classification. Because of many similarities between psychosomatic diseases and somatoform disorders, it is not always easy to differentiate between the these two groups. Therefore, the distinguishing characteristics of both groups were investigated from the DSM-III standpoint. As the objects of investigation, those cases which were diagnosed as having psychological factors (psychosomatic diseases) affecting their physical conditions and as those having somatoform disorders were selected from among inpatients at Toho University's Psychosomatic Medicine Ward, based on the DSM-III classification. As to the investigation method, a comparison of both groups was made by paying close attention to the stress intensity and social adaptability levels which were relevant in the DSM=III diagnosis, and a comparison of the overall ego-states was also made by paying close attention to distortion of the ego-structure. As a result, when psychc, logical and social stress was compared with the ratio occupying that of idiocy and more, that is, that of Code 5 or more, psychosomatic diseases were found to have a significant difference in eruption frequency as compared with somatoform disorders, whereas psychosomatic diseases were proven to manifest themselves due to strong and excessive stress as compared with somatoform disorders. On the other hand, a comparison regarding the socia; adaptation level did not show a significant difference between the two groups. Comparison of ego-grams showed that psychosomatic cases had a tendency of showing a significantly high value in the Adapted Child (AC) and also in the Critical Parent (CP). These results were thought to be helpful in differentiating the symptoms of both groups, and consequently it was confirmed to be clinically useful to grasp the psychological and social and stress intensities and to analyze egostates utilizing an ego-gram.

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The DSM=III diagnostic trial was performed on patients who visited the Department of Tokai Central Hospital. The relationship between psychosomatic disease and Somatoform Disorders, criticism of the application of the DSM=III, the reliability for diagnosis of psychosomatic disease and multiaxial evaluation of its disease were discussed on the basis of the diagnostic trial performed on these patients. We began by compiling a checklist necessary for the application of the DSM=III diagnosis. Three hundreds and four outpatients who were suffering from neurosis and psychosomatic disease visited the Clinic of Internal Medicine of Tokai Central Hospital and were evaluated using this precompiled checklist. On the basis of this checklist, 17.1% of the patients were Somatoform Disorders. These disorders consisted of Hypochondriasis, the most predominant in the group (51.9%); Conversion Disorder (25%) ; Somatization Disorder (13.5%); and Psychogenic Pain Disorder (9. 6%)' I have been aware of some problems of the DSM=III as a diagnostic method for psychosomatic disease. In some cases, it is difficult to discriminate Somatoform Disorders from Psychological Factors Affecting Physical Condition. It is also difiicult to define those terms which are diagnostic criteria for Psychological Factors Affecting Physical Condition, for example " psychologically meaningful environmental stimuli " and " known pathophysiological process." The definitions of these diagnostic term should be clarified prior to the application of the DSM=III in order to accurately diagnose psychosomatic disease. In Axis I, the group category of Psychological Factors Affecting Physical Condition should be subdevided into some clihical syndromes concerning psychosomatic disease. The important personality tendencies of psychosomatic disease such as alexithymia and characteristic behavior pattern should be considered for the inclusion in Personality Disorders. About Adaptive Functioning, it is necessary to describe whether or not the present adaptive level is lower than that of the past and is in over-function or not. The ethical aspect of psychosomatic disease had to be added as another axis for its evaluation. Deterioration of life style and the subsequent impairment of livelihood are deeply related to psychosomatic disease. This aspect is necessary for the generalized diagnosis of these patients suffering from psychosomatic disease.

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Effects of longterm isolation housing on duration of pentobarbitalinduced sleep were studied in mice. The experiments were performed from the viewpoint of interaction between housing condition (individual or aggregated) and testing condition (individual or aggregated). The conclusions were as follows.(1) Duration of pentobarbital-induced sleep was significantly influenced by housing condition of mice. Individual housing shortened the pentobarbitalinduced sleep as compared with aggregated housing (2) Duration of pentobarbitalinduced sleep was also significantly influenced by predrug and/or postdrug testing condition (individual or aggregated) of mice. (3) Mice housed in individual condition were more sensitive to postdrug testing condition (individual or aggregated) in the effect of pentobarbital as compared with mice housed in aggregated condition. (4) The results support that housing condition differently influences on the arousal level of the central nervous system in the different testing condition. (5) The results suggest that the predrug and/or postdrug testing condition should be carefully considered in experimental studies of the influence of housing condition on the effects of drugs acting on the central nervous system in mice.

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The patient was a 37-year old house wife who had been suffering from nausea and vomiting for eleven years. After wandering several hospitals, she visited our hospital in May, 1980 and was admitted there for six times. Her diagnosis, however, was not determined. So she was consulted with one oi our psychosomatists in April, 1984. After performing an interview and psy-choneuro-endocrinological exminations, we diagnosed her as a nervous vomiting with dysfunction of hypothalamus and deep mental troubles. We considered that her mental troubles had caused vomiting at frst by conversion mechanism and subsequently a disorder of hypothalamic function. It was assumed that her symptoms became severe and continued because of the hypothalamic dysfunction. In therapeutic management, we applied fasting therapy in order to improve symptoms by regulating hypothalamic dysfunction. We then applied nondirective psychotherapy for facilitating personality change by self insight. The patient was healed completely. After one year since her discharge, the patient is healh both in her physical and mental conditions without reccurrence.

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