Is physical disease missed in patients with medically unexplained symptoms? A long-term follow-up of 120 patients diagnosed with bodily distress syndrome

Objective: Bodily distress syndrome (BDS) was recently introduced as an empirically based, unifying diagnosis for so-called medically unexplained symptoms and syndromes. BDS relies on a specific symptom pattern rather than on a lack of objective findings, which may increase the risk of overlooking physical disease. We investigated whether physical disease was missed in the first patients diagnosed with BDS. Method: The study was a register-based follow-up study of 120 patients diagnosed with BDS at a University Clinic from 2005 to 2007. Median follow-up time was 3.7 years. We used data containing all diagnoses from inpatient, outpatient and emergency admissions supplied by systematic review of hospital records. Medical specialists evaluated all cases of suspected overlooked physical disease. Results: According to registered diagnoses, none of the 120 patients had been misdiagnosed with BDS. In five cases [4.2% (95% confidence interval: 1.4-9.5)] though, we found comorbid medical problems that had not been taken properly care of alongside BDS management. These were disc protrusion, degeneration and prolapsus, hip osteoarthritis, anemia and calcific tendinitis. Conclusion: The BDS symptom pattern reliably identified patients with multiple medically unexplained symptoms referred to tertiary care. Nevertheless, differential diagnostics remains important in order to identify comorbid medical problems that require additional treatment. (C) 2014 Elsevier Inc. All rights reserved.