Somatoform Disorder: An overview

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Somatoform Disorder

In somatoform disorders, psychological problems take a physical form (soma means “body”) that is the person who experiences bodily symptoms that have no known physical cause. These disorders are not under voluntary controls, nor are they intentionally produced by the person. People with these disorders tend to seek medical treatment, sometimes at great expense, and are typically distressed and confused when doctors are unable to provide a physiological explanation for their complaints (Kring, Davison, Neale & Johnson,2006).

Classification in DSM-IV and ICD-10

In DSM-IV, the overall term somatoform disorder is used to denote a group of a condition characterized by physical symptoms occurring without an adequate physical cause.in ICD-10, these disorders are not allocated a separate category; instead, they are classified as members of a wider category of neurotic-stress related, and somatoform disorder (Gelder& Harrison,2006).

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A further, potentially confusing difference between the classification is that in ICD-10 the condition called conversion disorder in DSM is a member of a group called dissociative disorders, while in DSM-IV conversion disorder is classified as a somatoform disorder (Gelder& Harrison,2006).

Neurasthenia is not included in DSM because the category is seldom used in the USA. It is included in ICD-10 because it is an international classification and the category is some far Eastern countries (Gelder & Harrison,2006).

Categories of somatoform disorders in ICD-10 and DSM-IV

ICD-10	DSM-IV-TR
Somatization disorder Undifferential somatoform disorder Hypocandraical disorder Somatoform autonomic disorder Persistent pain disorder Other somatoform disorders No Category No Category Neurasthenia	Somatization disorder Undifferential somatoform disorder Hypochondriasis No Category Pain disorder associated with psychological factors (and general medical conditions) Somatoform disorders not otherwise specified Body Dysmorphic disorder Conversion Disorder No Category

Table 1: Categories of Somatoform Disorders in ICD-10 and DSM-IV

Somatoform and Related Disorders

The following somatoform disorders are included in this section:

Somatization disorder

In 1859, the French Physician Pierre Briquet described a syndrome that was then called Briquet’s syndrome and is known as somatization disorder. This disorder is defined by multiple, recurrent somatic complaints that have no apparent physical explanation but still cause the person to seek treatment. To qualify for the diagnosis, a person must have several different kinds of physical symptoms and the symptoms must cause impairment (Kring, Davison, Neale & Johnson,2006).

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 2004), it is referred to as hysteria or Briquet’s syndrome. It is a polysymptomatic disorder that begins before age 30 years, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual, and pseudo neurological symptoms.

Undifferentiated Somatoform disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 1994), Undifferential somatoform disorder is characterized by unexplained physical complaints, lasting at least 6 months that are below the threshold for a diagnosis of somatization disorder.

Conversion disorder

A term conversion introduced by Freud for a hypothetical mechanism by which psychological stress leads to physical symptoms. It is the term used in DSM to replace the older term hysteria (Gelder& Harrison,2006).

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 2004), Conversion disorder involves unexplained symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition. Psychological factors are judged to be associated with the symptoms or deficits.

Pain disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 1994), Pain disorder is characterized by pain as the predominant focus of clinical attention, in addition, psychological factors are judged to have an important role in its onset, severity, exacerbation, or maintenance.

This term denotes patients with chronic pain that is not caused by any physical or specific psychiatric disorder (Gelder& Harrison,2006).

Hypochondriasis

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 2004), It is the preoccupation with the fear of having or the idea that one has a serious disease based on the person’s misinterpretation of bodily symptoms or bodily functions.

Body dysmorphic disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 2004), It is the preoccupation with an imagined or exaggerated defect in physical appearance.

Somatoform disorder not otherwise specified

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision, American Psychiatric Association, 2004), It is included for coding disorders with somatoform symptoms that do not meet the criteria for any of the specific somatoform disorders.

Summary of Somatoform and related disorders

Disorder	Description
Somatization disorder	Recurrent, multiple physical complaints that have no biological basis
Undifferentiated somatoform disorder	Unexplained physical complaints that below the threshold for a diagnosis with somatization disorder
Conversion disorder	Sensory or motor symptoms with no physiological cause
Pain disorder	Pain that is brought on and maintained to a significant extent by psychological factors
Hypochondriasis	Preoccupation with fears of having a serious illness
Body Dysmorphic disorder	Preoccupation with an imagined or exaggerated defect in physical appearance
Somatoform disorder not otherwise specified	Coding with somatoform symptoms that do not meet the criteria for any of the specific somatoform disorder

Table 2. Summary of somatoform and related disorders

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Cleveland clinic.(2013).Hypochondriasis.Retrieved on May 25, 2013, from http://my.clevelandclinic.org/disorders/hypochondriasis/hic_hypochondriasis.aspx
Encyclpedia of Mental Health.(2013).Somatoform disorder. Retrieved on May 25, 2013, from http://www.minddisorders.com/Ob-Ps/Pain-disorder.html#ixzz2UPh9yQj7
Gelder, M., Harrison.P., & Cowen, P. (2006).Shorter Oxford Textbook of Psychiatry.5th ed.Kring, A.M., Davison, G.C., Neale, J.M., & Johnson, S.L. (2006).Abnormal Psychology.10^th ed.

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