DSM 5 Updates, Bringing Mind and Body Together
The new DSM 5 (the standard in the assessment of mental health disorders) has been rolled out and as clinicians become more familiar with the changes, two disorders in particular has had significant changes in conceptualization.
The previous manual (DSM IV-TR) contained somatization disorder which consisted of such stringent criteria that it’s diagnosis was made very difficult and rare. This diagnosis required a host of somatic (physical) symptoms including pain, gastrointestinal, sexual and neurological issues, and one of the cornerstones of the criteria was that medical investigation failed to prove a physical cause of the patient’s complaints (the physical symptoms were coming from psychiatric distress).
Renamed Somatic symptom disorder (consistent with a trend towards simplification of nomenclature), medical investigation failing to reveal a physical cause of the symptoms is no longer part of the criteria. This emphasizes the fact that the individual has a legitimate suffering and also that there are limits to medical assessments, such that complete certainty of the absence of a physical cause is highly difficult to determine in certain cases. DSM 5 has also attempted to reduce the separation of the mind and body, also reflected in this change in the diagnostic criteria for somatic symptom disorder (that is, regardless of whether a physical cause is identified, it is still considered the same disorder). This disorder can apply to individuals with a diagnosed medical condition with a known cause. For example, if someone had a kidney disorder, and they constantly misinterpreted normal physical body sensations as a worsening of their condition, and this became emotionally distressing, could qualify for somatic symptom disorder. Likewise, medically unexplained physical pain and fatigue could also qualify for the disorder, assuming this also caused emotional distress for the patient.
A key feature of somatic symptom disorder is that the individual spends excessive time and energy, has elevated anxiety levels, and large amounts of thought content devoted to the somatic symptoms they are experiencing.
People who had previously been diagnosed with hypochondriasis now would meet criteria for somatic symptom disorder, in that these are people that have physical symptoms (possibly harmless, normal sensations such as getting lightheaded when standing too quickly) that they perceive as a serious illness, and are not reassured when labs and investigations come back without any disorder identified. If they do not have many physical symptoms but are still anxious about having a medical illness, now they could be diagnosed as having illness anxiety disorder. Hypochondriasis, with somatization disorder, have been retired in DSM 5, and replaced with illness anxiety disorder and somatic symptom disorder.
© Neevon Esmaili 2016
Reference: DSM 5, DSM IV-TR
Neevon Esmaili, MD
Child Adolescent, & Adult Psychiatrist
Dual Board Certified
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