Somatoform Disorders: Types, Symptoms, and Diagnosis
Somatoform Disorders
F45.0 Somatization Disorder (300.81)
A. History
Many physical complaints beginning before age 30, persist for several years and force the patient to seek medical attention or cause significant impairment in social, occupational, or other important areas of functioning.
B. Criteria
Must satisfy all of the criteria set out below, and each symptom can occur at any time during the disorder:
- Four pain symptoms: a history of pain related to at least four areas of the body or four functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, intercourse, or urination)
- Two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting [not during pregnancy], diarrhea, or intolerance to various foods)
- One sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting during pregnancy)
- One pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired psychomotor coordination or balance, paralysis or localized weakness, difficulty swallowing, feeling a lump in the throat, aphonia, urinary retention, hallucinations, loss of touch or pain, diplopia, blindness, deafness, seizures, symptoms such as dissociative amnesia, or loss of consciousness other than fainting)
* If there is a medical condition, physical symptoms or social or occupational impairment are excessive compared to what would be expected from the medical history, physical examination, or laboratory findings.
F45.1 Undifferentiated Somatoform Disorder (300.81)
A. Symptoms
One or more physical symptoms (e.g., fatigue, loss of appetite, gastrointestinal or urinary symptoms).
B. Characteristics
- After appropriate investigation, the symptoms cannot be explained by the presence of a known medical condition or the direct effects of a substance (e.g., drug abuse or medication).
- If there is a medical condition, physical symptoms or social or occupational impairment are excessive compared to what would be expected from the medical history, physical examination, or laboratory findings.
D. Duration
The duration of the disorder is at least 6 months.
E. Exclusion
The disturbance is not better accounted for by another mental disorder (e.g., another somatoform disorder, sexual dysfunction, mood disorder, anxiety disorder, sleep disorder, or psychotic disorder).
F44 Conversion Disorder (300.11)
A. Symptoms
One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or medical disease.
B. Psychological Factors
Psychological factors are considered to be associated with the symptom or deficit because the initiation or exacerbation of the condition is preceded by conflicts or other stressors.
F. Exclusion
The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.
Code based on the type of symptom or deficit:
- .4 With seizures
- .5 With mixed presentation
- .6 With motor symptom or deficit
- .7 With sensory symptom or deficit
F45.4 Pain Disorder
A. Main Symptom
The main clinical symptom is localized pain in one or more areas of the body, of sufficient severity to warrant medical attention.
B. Impairment
The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. Exclusion
The pain is not better accounted for by the presence of a mood disorder, an anxiety disorder, or a psychotic disorder and does not meet the criteria for dyspareunia.
Code as follows:
Pain Disorder Associated with Psychological Factors (307.80):
Psychological factors are thought to play an important role in the onset, severity, exacerbation, or persistence of pain (if there is a medical condition, it does not play an important role in the onset, severity, exacerbation, or persistence of pain). This type of pain disorder is not diagnosed if criteria are also met for somatization disorder.
Pain Disorder Associated With Psychological Factors and Medical Condition (307.89):
Both psychological and medical conditions play an important role in the onset, severity, exacerbation, or persistence of pain. The associated medical condition and anatomical location (see below) are coded on Axis III.
Specify (for both) if:
- Acute: duration of less than six months.
- Chronic: duration of six months or more.