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OBJECTIVE: DSM-III introduced somatoform disorders as a speculative diagnostic category for somatic symptoms "not explained by a general medical condition." Although retained and enlarged in DSM-IV, somatoform disorders have been the subject of continuing criticism by both professionals and patients. The extended period of preparation for DSM-V offers an important opportunity to reconsider the category of somatoform disorders. METHOD: Exploration of the diverse aims of a diagnostic classification indicates that the authors must not only address the conceptual and practical problems associated with this category but also reconcile it with the parallel medical descriptive classification of functional symptoms and syndromes. RESULTS: The existing somatoform disorders categories require modification. The authors favor the radical option of the abolition of the categories. Diagnoses currently within somatoform disorders could be redistributed into other groupings, and the disorders currently defined solely by somatic symptoms could be placed on axis III as "functional somatic symptoms and syndromes." Greater use could be made of "psychological factors affecting medical condition" on axis I. The authors suggest supplementing the diagnosis of functional somatic symptoms with a multiaxial formulation. CONCLUSIONS: The authors promote a classification of somatic symptoms in DSM-V that is compatible with that used in general medicine and offers new opportunities both for research into the etiology and treatment of symptoms and for the greater integration of psychiatry into general medical practice.

Objective: The goals of this study are to provide estimates of the prevalence of seasonal affective disorder in Alaska, to examine sociodemographic correlates, and to evaluate the relation between seasonal affective disorder and general depression. Method: A random sample of283 residents ofFairbanks who had lived in Alaska for 3 years or more were interviewed with the Seasonal Pattern Assessment Questionnaire and the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Results: Twenty-six (9.2%) of the subjects met diagnostic criteria for seasonal affective disorder, one of the highest figures yet reported. These cyclic winter affective disorders occurred more often in women than men (ratio=3:2) and were less prevalent among residents who were older than 40 years ofage. Assessment ofdepression with the CES-D Scale supported the diagnostic classification ofrespondents and the differentiation of seasonal affective disorder from other depression. Conclusions: This study supports the conclusions that seasonal affective disorder is prevalent in northern populations and that sex and age may represent the major risk factors that differentiate it from the general experience of depression in northern communities. (AmJ Psychiatry 1992; 149:1176-1182)

Denial of physical illness is a commonly encountered problem in consultation-liaison psychiatry. Although there is an extensive literature on denial, it has virtually ignored the diagnostic issues raised by the individual whose denial of physical illness is clearly maladaptive. The authors propose that DSM-IV include a subtype of adjustment disorder called "with maladaptive denial of physical disorder." They discuss this new category, its differential diagnosis, and the benefits to clinical practice of this proposed addition to diagnostic classification.

Speech samples from 71 patients in four diagnostic groups were analyzed by two quantitative methods of speech content analysis, the results of which were entered into a discriminant analysis to test whether patients could be accurately classified back into their appropriate diagnostic groups. These classifications were compared with classifications made by two psychiatrists, blind to the patients' diagnoses, who read transcripts of the speech samples. The results suggest that data from the systematic quantification of lexical choice can be used to classify patients into their respective diagnostic groups and that this classification compares favorably with that done by psychiatric raters.

Borderline patients may be distinguished from patients with personality disorders through the former's use of transitional objects. The transitional relatedness of the borderline patient is generally rigid and maladaptive. By comparison, transitional relatedness, both past and present, is essentially absent in patients with severe character disorders. The borderline patient's capacity for transitional relatedness indicates achievement of a developmental level that has implications for diagnostic classification and psychotherapeutic strategy.

One of the most important factors in the proper treatment of convulsions is a correct diagnosis. This point need not be stressed to psychiatrists or to neurologists but it does bear emphasis. Even recent textbooks in pediatrics refer to “convulsions in childhood,” or “fits in children,” as if such terminology signified a diagnostic classification. Therefore, I should like to present first a clinical classification of the convulsions of childhood. This classification may not be complete but it presents a clinician’s viewpoint or interpretation of the seizures which he sees in practice and which he must attempt to diagnose and treat. The basis for the logical grouping of the diagnoses of convulsions according to age periods has been previously explained.1

Even a brief report of the development of German psychiatry since 1945 should not omit a reference to a dominant tradition, characterized by the names of Kraepelin and Jaspers. Last year we celebrated the centennial of Kraepelin. On this occasion a great deal was written about the significance of his ideas in our time. We no longer share Kraepelin’s conception of human nature. We have lost interest in the nuances of his differentiation of various forms of insanity and, by the way, Kraepelin’s schema of the non-psychotic mental abnormalities has never been accepted. On the other hand, the diagnostic classification of the so-called endogenous psychoses, dividing them into the two groups of dementia praecox-now, following E. Bleuler, called the schizophrenias-and manic-depressive insanity-now called cyklothymia-is still widely accepted. Atypical forms as well as borderline cases were also known to Kraepelin. However, he doubted the occurrence of “real transitions” and believed firmly in the basic differences between these pathological processes. In relation to this problem our views over there are not as divergent as may appear at first glance. Kleist assumes two main groups; he distinguishes “phasic diseases” and “deteriorating diseases” (the schizophrenias), dividing them into about 40 subgroups to which he assigns atypical and intermediate cases. Kretschmer speaks about constitutional and hereditary spheres (schizothymcyklothym) which, just as they overlap in the area of the normal, may also be mixed in the area of character disorders and of psychoses. Therefore, Kretschmer postulates that atypical cases and intermediate forms which are transitional from schizophrenia to the manic-depressive should be considered as “genuine biological alloys.” K. Schneider rejects this assumption: to him such cases are