DSM-5 Essentials: The Savvy Clinician's Guide to the Changes in Criteria by Lourie W. Reichenberg

Author:Lourie W. Reichenberg
Language: eng
Format: mobi
ISBN: 9781118846094
Publisher: Wiley
Published: 2013-11-17T22:00:00+00:00

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SOMATIC SYMPTOM AND RELATED DISORDERS

This new chapter in DSM-5 identifies disorders characterized by thoughts, feelings, and behaviors related to somatic symptoms (previously referred to in DSM-IV as Somatoform Disorders). People who experience somatic symptoms frequently present in doctor's offices and other medical settings with symptoms that may result from medical disorders, may result from concern about a medical disorder, or may be factitious and inconsistent with any known medical or psychological disorder. Diagnosticians must use care, because neither the absence of a medical explanation nor the presence of a psychological problem automatically rules out the other.

One of the biggest changes in this section is the removal of unexplained symptoms as a key feature of somatic symptom disorders. For example, persons diagnosed under the new DSM-5 guidelines with somatic symptom disorder may or may not have a diagnosed medical condition. The key feature of each somatic disorder is an excessive response—marked thoughts, feelings, and behaviors in excess of what would be expected—related to somatic symptoms. The new chapter on Somatic Symptom and Related Disorders is intended to provide clarification of the boundaries between disorders, minimize overlap between somatic disorders, and reduce the number of disorders and their subcategories.

For example, many of the somatoform disorders in DSM-IV have been reconceptualized in DSM-5. Pain disorder is now diagnosed as a specifier to Somatic Symptom Disorder (e.g., “with predominant pain”). Conversion disorder has been renamed Conversion Disorder (Functional Neurological Symptom Disorder), and hypochondriasis has been clarified, so that three-quarters of the people who met the criteria for hypochondriasis under DSM-IV would now be diagnosed with somatic symptom disorder in DSM-5. The other 25% who have high health-related anxiety but do not present with somatic symptoms would be diagnosed with illness anxiety disorder. More will be said about these changes later.

All of the disorders included in this new chapter share a preoccupation with somatic symptoms. Some may involve an unsubstantiated belief about a person's illness or the illness of another (as in factitious disorder), some may result from medically unexplained symptoms (as in functional neurological symptom disorder), and some may adversely affect an already known medical condition (such as anxiety aggravating asthma, or poor adherence to treatment). Each of the somatic symptom and related disorders is discussed in greater detail.

ICD CODE AND DSM SPECIFIERS

SOMATIC SYMPTOM AND RELATED DISORDERS

ICD-9-CM Code Diagnosis ICD-10-CM Code

300.82 Somatic Symptom Disorder F45.1

300.7 Illness Anxiety Disorder F45.21

300.11 Conversion Disorder (Functional Neurological Symptom Disorder)

(ICD-10 codes are based on specific symptoms; refer to DSM-5, pp. 318–319.)

316 Psychological Factors Affecting Other Medical Conditions F54

300.19 Factitious Disorder F68.10

300.89 Other Specified Somatic Symptom and Related Disorder F45.8

300.82 Unspecified Somatic Symptom and Related Disorder F45.9

Somatic Symptom Disorder

Unlike DSM-IV's somatization disorder, somatic symptom disorder in DSM-5 does not require specific physical or sexual symptoms, occurrence before the age 30, or the presence of pain. Rather, somatic symptom disorder Criterion A requires a minimum of one somatic symptom that results in significant disruption of everyday life. Criterion B requires actions, thoughts, or feelings about the symptoms that are

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