老年躯体痛苦障碍的临床诊治进展

doi:10.3969/j.issn.1003-9198.2026.08.005

摘要/Abstract

摘要： 根据WHO数据,2050年全球60岁以上人口预计达到21亿,占总人口比例的22%。随着人口老龄化问题的加剧,躯体痛苦障碍(bodily distress disorder,BDD)作为老年人群常见的心身健康问题之一,越来越受到临床与公共卫生关注。BDD以对躯体不适的过度关注与担忧为核心特征,常伴随情绪、认知及社会功能异常,不仅显著降低老年人的生活质量,也耗费大量的医疗资源。老年BDD的临床表现更为隐匿复杂,易与多种躯体疾病共病,识别与干预难度较大。本文系统梳理了国内外相关研究成果,对目前老年BDD的研究现状与诊疗进展进行综述,以期为老年BDD的临床识别、规范化管理与后续研究提供参考依据。

关键词: 老年人, 躯体痛苦障碍, 诊断, 治疗

Abstract: According to statistics released by the World Health Organization (WHO), the global population aged 60 years and over is projected to reach 2.1 billion by 2050, accounting for 22% of the total global population. With the progressive intensification of population aging, bodily distress disorder (BDD), as one of the prevalent psychosomatic health conditions in the elderly population, has garnered growing attention in the fields of clinical practice and public health. Characterized by core symptoms of excessive attention to and preoccupation with physical discomfort, BDD is often accompanied by abnormalities in emotional regulation, cognitive function, and social functioning. It not only significantly impairs the quality of life of elderly patients but also imposes a substantial burden on medical resources. Notably, the clinical manifestations of geriatric BDD are more insidious and complex, and it is highly prone to comorbidity with various physical diseases, which renders its identification and intervention relatively challenging. In this review, we systematically collate relevant research findings at home and abroad, summarize the current research status and diagnosis and treatment advances in geriatric BDD, aiming to provide a theoretical reference for its clinical identification, standardized management, and subsequent research.

Key words: aged, bodily distress disorder, diagnosis, treatment

中图分类号:

R 749.2

吴珩, 袁勇贵. 老年躯体痛苦障碍的临床诊治进展[J]. 实用老年医学, 2026, 40(8): 775-780.

WU Heng, YUAN Yonggui. Advances in the clinical diagnosis and treatment of geriatric somatic distress disorder[J]. Practical Geriatrics, 2026, 40(8): 775-780.

参考文献

[1] LEVIN Y, RAHAMIM T, BACHEM R, et al. Measuring ICD-11 bodily distress disorder symptoms: the development and initial validation of the bodily distress inventory (BoDI)[J]. J Psychiatr Res, 2026, 198:85-93.
[2] 陈子晨, 汪新建. 从DSM-Ⅳ躯体形式障碍到DSM-5躯体症状障碍[J]. 心理科学进展, 2013, 21(11): 1967-1975.
[3] LEVIN Y, RAHAMIM T, BACHEM R, et al. Measuring ICD-11 bodily distress disorder symptoms: the development and initial validation of the bodily distress inventory (BoDI)[J]. J Psychiatr Res, 2026, 198: 85-93.
[4] GUREJE O, DE GUZMAN M L R, KHALED S M, et al. The epidemiology of ICD-11 bodily distress disorder and DSM-5 somatic symptom disorder in new large-scale population surveys within the World Mental Health Survey Initiative[J]. World Psychiatry, 2025, 24(3): 395-403.
[5] DEHOUST M C, SCHULZ H, HÄRTER M, et al. Prevalence and correlates of somatoform disorders in the elderly: results of a European study[J]. Int J Methods Psychiatr Res, 2017, 26(1): e1550.
[6] WU Y, TAO Z, QIAO Y, et al. Prevalence and characteristics of somatic symptom disorder in the elderly in a community-based population: a large-scale cross-sectional study in China[J]. BMC Psychiatry, 2022, 22(1): 257.
[7] HALLER H, CRAMER H, LAUCHE R, et al. Somatoform disorders and medically unexplained symptoms in primary care: a systematic review and meta-analysis of prevalence[J]. Cochrane Database Syst Rev, 2015, 18 (9):CD007193.
[8] SIIG E J P, HVIDTFELT LYKKE V M, MANTILLA HERRERA A M, et al. The prevalence and estimated burden of somatoform disorders: a systematic review and meta-analysis of their epidemiology[J]. Lancet Psychiatry, 2025, 12(12): 883-892.
[9] LÓWE B, LEVENSON J, DEPPING M, et al. Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis[J]. Psychol Med, 2022, 52(4): 632-648.
[10] 中华医学会心身医学分会躯体症状及相关障碍学组, 上海市医学会心身医学专科分会.躯体症状障碍多学科诊疗专家共识[J].中华精神科杂志, 2024, 57(2):65-77.
[11] YANG X, LUO J, WANG P, et al. Characteristics and economic burden of patients with somatoform disorders in Chinese general hospitals: a multicenter cross-sectional study[J]. Ann Gen Psychiatry, 2023, 22(1): 30.
[12] SEO J H, HAN M, KANG S, et al. Healthcare utilization and costs in patients with somatic symptom and related disorders compared with those with depression and healthy controls: a nationwide cohort study[J]. Depress Anxiety, 2024, 2024(1): 8352965.
[13] BALLERING A V, BONVANIE I J, OLDE HARTMAN T C, et al. Gender and sex independently associate with common somatic symptoms and lifetime prevalence of chronic disease[J]. Soc Sci Med, 2020, 253: 112968.
[14] BHATTI F R, TARIQ R, HUSSAIN R, et al. Frequency and correlates of somatic symptoms in patients of depression: a cross-sectional study at PIMS Islamabad[J]. Ann Med Surg, 2026, 88(3): 2262-2268.
[15] EFREMOV A. Psychosomatics: communication of the central nervous system through connection to tissues, organs, and cells[J]. Clin Psychopharmacol Neurosci, 2024, 22(4): 565-577.
[16] 董辽, 梁怀彬, 杨光, 等. 基于概率性纤维追踪的躯体症状障碍患者脑网络初步探究[J]. 磁共振成像, 2022, 13(7): 80-83, 130.
[17] 时小晗, 杜思敬, 杨波, 等. 自主神经功能监测在躯体症状障碍病人临床评估中的研究进展[J]. 中国疼痛医学杂志, 2025, 31(4): 243-249.
[18] HARVEY A R. Injury, illness, and emotion: a review of the motivational continuum from trauma through recovery from an ecological perspective[J]. Brain Behav Immun Health, 2023, 27: 100586.
[19] LÓWE B, ANDRESEN V, VAN DEN BERGH O, et al. Persistent SOMAtic symptoms ACROSS diseases—from risk factors to modification: scientific framework and overarching protocol of the interdisciplinary SOMACROSS research unit (RU 5211)[J]. BMJ Open, 2022, 12(1): e057596.
[20] SOMMER C, RITTNER H. Pain research in 2023: towards understanding chronic pain[J]. Lancet Neurol, 2024, 23(1): 27-28.
[21] CLIFFORD C, TWERENBOLD R, HARTEL F, et al. Somatic symptom disorder symptoms in individuals at risk for heart failure: a cluster analysis with cross-sectional data from a population-based cohort study[J]. J Psychosom Res, 2024, 184: 111848.
[22] CHEN J, MA D, CAO J, et al. Alexithymia mediates the pathway from negative life events to somatic symptoms: a cross-sectional study in a psychosomatic outpatient sample[J]. Frontiers in Psychiatry, 2025, 16: 1680463.
[23] SAUER K S, MOHR A K, WITTHÓFT M. Somatic symptom distress, health anxiety, alexithymia, and emotion generation: results of an evidence accumulation model[J]. Biopsyc Sci Med, 2026, 88(4):350-359.
[24] VOS A E C C, JONGEN E M M, VAN DEN HOUT A J H C, et al. Loneliness in patients with somatic symptom disorder[J]. Scand J Pain, 2023, 23(2): 291-297.
[25] WÜNSCHE S, KREMPEL L, MARTIN A. Short report: somatic symptoms and associated psycho-behavioural variables: the mediating role of loneliness[J]. J Psychosom Res, 2026, 205: 112615.
[26] 郑恩雨, 王可, 冯雪竹, 等. 躯体症状障碍相关研究进展[J]. 中国药物依赖性杂志, 2022, 31(6): 407-410, 416.
[27] IONESCU C G, POPA-VELEA O, MIHÄILESCU A I, et al. Somatic symptoms and sleep disorders: a literature review of their relationship, comorbidities and treatment[J]. Healthc Switz, 2021, 9(9): 1128.
[28] ÇOLAK B, EKEN A, KUMAN A, et al. The relationship of cortical activity induced by pain stimulation with clinical and cognitive features of somatic symptom disorder: a controlled functional near infrared spectroscopy study[J]. J Psychosom Res, 2021, 140: 110300.
[29] TOUSSAINT A, HÜSING P, KOHLMANN S, et al. Detecting DSM-5 somatic symptom disorder: criterion validity of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder-B Criteria Scale (SSD-12)[J]. Psychol Med, 2020, 50(2): 324-333.
[30] JIANG Y, WEI J, FRITZSCHE K, et al. Assessment of the structured clinical interview (SCID) for DSM-5 for somatic symptom disorder in general hospital outpatient clinics in China[J]. BMC Psychiatry, 2021, 21(1): 144.
[31] MALAS N, ORTIZ-AGUAYO R, GILES L, et al. Pediatric somatic symptom disorders[J]. Curr Psychiatry Rep, 2017, 19(2): 11.
[32] BEREZOWSKI L, LUDWIG L, MARTIN A, et al. Early psychological interventions for somatic symptom disorder and functional somatic syndromes: a systematic review and meta-analysis[J]. Psychosom Med, 2022, 84(3): 325-338.
[33] MAAS GENANNT BERMPOHL F, MARTIN A. Efficacy of cognitive behavioral therapy and acceptance-and mindfulness-based treatments in adults with bodily distress: a network meta-analysis[J]. Psychother Psychosom, 2025, 94(3): 207-224.
[34] 尹志香, 刘飞艳, 王俊凤. 认知行为干预对首发躯体形式障碍患者的影响[J]. 心理月刊, 2024, 19(3): 185-187.
[35] SHEN H, ZHANG R, ZHANG X, et al. Moderating effect of mindfulness on the relationship between anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension[J]. J Clin Hypertens, 2023, 25(7): 647-654.
[36] TOWN J M, ABBASS A, CAMPBELL S. Halifax somatic symptom disorder trial: a pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department[J]. J Psychosom Res, 2024, 187: 111889.
[37] LILLIENGREN P, LJUNGDAHL M, RÓÓST M, et al. Online intensive short-term dynamic psychotherapy (ISTDP) for treatment-resistant somatic symptom disorder: an interrupted time-series study[J]. Psychother Psychosom, 2026, 2:1-6. doi: 10.1159/000550629. Online ahead of print.
[38] LUMLEY M A, SCHUBINER H. Psychological therapy for centralized pain: an integrative assessment and treatment model[J]. Biopsychosom Med, 2019, 81(2): 114-124.
[39] ASHAR Y K, GORDON A, SCHUBINER H, et al. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial[J]. JAMA Psychiatry, 2022, 79(1): 13-23.
[40] YARNS B C, JACKSON N J, ALAS A, et al. Emotional awareness and expression therapy vs cognitive behavioral therapy for chronic pain in older veterans: a randomized clinical trial[J]. JAMA Netw Open, 2024, 7(6): e2415842.
[41] 张亚同, 孙雪林. 我国老年人药物治疗现状和常见用药误区[J]. 中国合理用药探索, 2025, 22(11): 14-19.
[42] FURUTANI N, NAGOSHI Y. Vortioxetine as an alternative treatment for somatic symptom disorder: case report[J]. Front Psychiatry, 2024, 15: 1496072.
[43] NEIL-SZTRAMKO S E, LEVY A, FLINT A J, et al. Pharmacological treatment of anxiety in older adults: a systematic review and meta-analysis[J]. Lancet Psychiatry, 2025, 12(6): 421-432.
[44] KLEINSTÄUBER M, WITTHÓFT M, STEFFANOWSKI A, et al. Pharmacological interventions for somatoform disorders in adults[J]. Cochrane Database Syst Rev, 2014, 2014(11): CD010628.
[45] ORIUWA C, MOLLICA A, FEINSTEIN A, et al. Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review[J]. J Neurol Neurosurg Psychiatry, 2022, 93(3): 280-290.
[46] KUMAR N, SINGAL P, CHAKLADAR A. Novel intervention of high-frequency repetitive transcranial magnetic stimulation in patients with somatic symptom disorder and its safety and outcome[J]. Indian J Psychiatry, 2023, 65(8): 887-891.
[47] 杨帅, 胡红星. 重复经颅磁刺激在抑郁症治疗中的研究进展[J]. 国际精神病学杂志, 2024, 51(4): 1026-1029.
[48] WAN S, LI J, LIAO Y, et al. Clinical study on the treatment of somatisation disorder with repetitive transcranial magnetic stimulation combined with venlafaxine[J]. Actas Esp Psiquiatr, 2025, 53(6): 1176-1186.
[49] 包炤华, 过婷, 张凯, 等. 舒肝解郁胶囊联合艾司西酞普兰治疗老年抑郁症伴失眠疗效及作用机制[J]. 现代中西医结合杂志, 2020, 29(30): 3385-3389.