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Letters to the Editor

plement those already available in the literature, the Diagnostic Criteria for Psychosomatic Research (DCPR) (2). There are some recent data which are relevant to their discussion (1). The DCPR criteria were used in a sample of 190 patients with functional gastrointestinal disorders (3). Demoralization was found to occur in about a quarter of the patients. In another investigation of 129 patients who underwent heart transplant surgery (4), DCPR demoralization was found to be present in 32% of cases. In both studies there was a certain overlap between demoralization and DSM-IV mood disorders. However, not more than a half of the patients with mood disorders also presented with demoralization. Further, DCPR diagnoses were double (3) or triple (4) the DSM diagnoses. These data have several implications. First, they confirm that demoralization is frequently encountered in the setting of medical disease. Second, psychiatric diagnostic criteria appear to be less suitable than psychosomatic criteria such as the DCPR in the medically ill (5). Finally, demoralization and depression can be differentiated. This has led to a modification of DCPR criteria (5), in the sense that the exclusion of a psychiatric diagnosis is not longer requested. Only comparative studies may ascertain whether the criteria elaborated by Kissane et al. (1) or those included in the DCPR (5) are more suitable in the medically ill. We suggest, however, that demoralization also be diagnosed in the presence of mood disorders.