This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Somatic Symptom and Related Disorders in the DSM-5 by Lori Parker
Previously known as Somatoform Disorders in the DSM-IV-TR, the DSM-5 brought about several changes to this class of disorders, beginning with a name change to Somatic Symptom and Related Disorders. One of the most substantial changes was the removal of the criteria that the somatic symptoms have no medical explanation. In removing this emphasis, it is believed that the stigma of patients making up their symptoms will be lessened. Other changes include, removing disorders, combining disorders, moving disorders to other categories, and adding two new disorders.
Unlike most other mental disorders, people suffering from Somatic Symptom and Related Disorders are primarily seen in a primary care setting or hospital instead of a psychiatric setting. As many of those with Somatic Symptom and Related Disorders are seen by physicians, revisions to the DSM-5 attempted to make it easier and more useful for physicians to use the DSM in assessing a patient. The DSM-IV-TR was confusing due to “the overlap of somatoform disorders with the classification used by practitioners of internal medicine” (Mayour, Kirmayer, Simon, & Sharpe, 2005).
Two disorders seen in the DSM-IV-TR that were removed from the DSM-5 are Hypochondriasis and Pain Disorder. Both of these disorders were removed due to large amounts of overlap between each disorder and other disorders. Many people previously diagnosed with Hypochondriasis could now be diagnosed with Somatic Symptom Disorder or Illness Anxiety Disorder. Those previously diagnosed with Pain Disorder could now qualify for one of several disorders: Somatic Symptom Disorder with predominate pain, Psychological Factors Affecting other Medical Conditions, or an adjustment disorder (American Psychiatric Association, 2013).
Somatization Disorder and Undifferentiated Somatoform Disorder were combined under the new heading Somatic Symptom Disorder. The DSM-5 states that these two disorder were combined because division between the two was not based on any evidence. One of the key features to Somatic Symptom Disorder is excessive thoughts, feelings, or behaviors related to somatic symptoms or health concerns.
Two disorders were combined under the Other Specified Somatic Symptom and Related Disorders section. These are Other Specified Somatic Symptom Disorder and Other Specified Illness Anxiety Disorder. This category, formally Somatoform Disorder Not Otherwise Specified, now contains Brief Somatic Symptom Disorder (formally Other Specified Somatic Symptom Disorder), Brief Illness Anxiety Disorder (formally Other Specified Illness Anxiety Disorder), Illness Anxiety Disorder Without Excessive Health-related Behaviors, and Pseudocyesis (a false belief of being pregnant).
Another shift in DSM-5 was that Body Dysmorphic Disorder was moved to Obsessive-Compulsive and Related Disorders (BDD). In BDD, individuals have obsessive thoughts about an unreal or exaggerated defect in physical appearance. As this disorder is more focused on obsessive thoughts, versus somatic symptoms, it was moved out of the new Somatic Symptom and Related Disorders category.
Psychological Factors Affecting Other Medical Conditions is a new diagnosis added to the DSM-5. Previously, in the DSM-IV-TR, this disorder was listed under “Other Conditions That May Be a Focus of Clinical Attention.” Key features of this disorder, are having a medical condition (other than a mental disorder) and having a psychological or behavioral factor that negatively affects the medical condition that are not better explained by another mental disorder. Some examples of Psychological Factors Affecting Other Medical Conditions are not consistently taking medication for hypertension, anxiety exacerbating asthma, or ignoring symptoms of a heart attack.
Illness Anxiety Disorder is a new disorder added to the DSM-5. Key features of Illness Anxiety Disorder or is a preoccupation with having or getting a serious illness, an absence of somatic symptoms (or only mildly intense somatic symptoms if they are present), and the anxiety cannot be better explained by another Anxiety Disorder. There are two types of Illness Anxiety Disorder: care-seeking type and care-avoidant type. In care-seeking type, a person frequently uses medical care for physician’s visits to undergo tests and procedures. In care-avoidance type medical are is rarely used.
Few changes occurred to the Conversion Disorder (Functional Neurological Symptom Disorder). Conversion Disorder requires clear evidence that the somatic symptoms are incompatible with a neurological disease. Criteria have been revised to emphasize the importance of the neurological exam, reducing the emphasis on the psychological basis of symptoms.
Factitious Disorder and Factitious Disorder Imposed on Another (formally Factitious Disorder by Proxy) were moved from their own category into the Somatic Symptom and Related Disorders. According to the DSM-5, these disorders were added due to the fact that somatic symptoms are the predominate feature. Also, like the other disorders in the category, care is generally sought in the medical setting versus the mental health setting.
These changes have reduced some of the overlap seen in previous editions of the DSM, making it easier for physicians in medical setting to diagnosis a patient with one of the Somatic Symptom and Related Disorders. The de-emphasis of having no medical explanation for the somatic symptoms will hopefully reduce the stigma associated with having one of these disorders. Also, it is hoped that persons with a Somatic Symptom and Related Disorder will now feel like they are believed when entering a primary care setting with a somatic complaint. Despite the numerous changes to this class of disorders, much more research needs to be completed for a better understanding of persons with, and the disorder themselves in, Somatic Symptom and Related Disorders. As many of those presenting with somatic symptoms are seen more often in a primary care setting, more cooperation between physicians and psychiatrists/psychologists needs to occur in order to correctly diagnosis a person with either Somatic Symptom and Related Disorder, an Anxiety Disorder, a Depressive Disorder, or a medical disease.