Author's response to reviews Title:Bodily distress syndrome: A new diagnosis for functional disorders in primary care? Authors:

The abstract reads well Background The literature review is sound and the concept of BDS, though reported in the literature previously, is currently presented to a wider readership in primary care. One consideration of such a catch-all category which captures a spectrum of disorders is how to classify severity, duration and level of associated disability – currently it is unclear the duration required for a diagnosis of BDS. Comment 1: The literature would also indicate that the longer someone has a disorder (somatoform/functional/etc.), the increased likelihood for intractability. The current model does not comment on this and if patients were tracked longitudinally, this could lead to varying findings given that cohorts of people with BDS may not exactly correspond e.g. one group of BDS may have a median illness duration for 1 year versus another cohort with mean illness duration for 8 years. Response: We agree with the reviewer that time is an issue, especially with regard to prognosis. However, this is no different from the current diagnoses for functional disorders. Comment 2: There are numerous cultures that have a tendency to somatise and the construct of BDS has been validated in predominantly Western contexts, how this translates to other settings is yet to be seen. Response: We agree that this point is highly important. Under the auspices of WHO, field trial studies are currently being performed worldwide; this also includes primary care populations in Brazil, Mexico, Spain, Pakistan and Hong Kong. Results have not yet been published, and rigorous trials in other cultures are called for.