Report of the DSM-V Somatic Distress Disorders Work Group
April 2009
Joel Dimsdale, M.D.
The Somatic Symptoms Workgroup (SSW) is examining the mental disorders that are marked principally by their somatic symptoms. Patients with these disorders are commonly seen in non-psychiatric settings, but are rather rare in psychiatric practice settings.
Most of these disorders are organized in the DSM-IV under the heading of “Somatoform Disorders.” However that term itself is confusing to most medical professionals. Thus, the group is exploring different names that may more clearly denote the diagnostic territory of these disorders. “Somatic Symptom Disorders” is the current term under discussion.
The workgroup is exploring whether some of these disorders have so many common features that they may be meaningfully combined into a smaller number of disorders. Factitious disorders, for instance, in DSM–IV-TR, have 3 subtypes, and it little evidence has been found that value is gained by having all of these subtypes in the manual.
More controversial is a proposal the group has been examining, which would combine somatization disorder, hypochondriasis, pain disorder and undifferentiated somatoform disorder into one overarching disorder (tentatively entitled, “complex somatic symptom disorder”). The hallmark of this disorder would be somatic symptoms associated with significant distress and disability. In some cases the patient’s response is disproportionate and maladaptive. Our group is exploring the potential for eliminating criteria such as “medically unexplained symptoms” as a marker of this disorder because such considerations are commonly unreliable, divisive between doctor and patient and lead to mind-body dualism.
The SSW is considering the placement of various disorders either within this grouping or moving them elsewhere in the nomenclature. We are considering importing into this section what was called in DSM–IV, “Psychological factors affecting general medical condition” (PFAGMC). There is active discussion about the contours of this disorder which is actually one of the more commonly diagnosed disorders with a decidedly somatic focus. On the other hand, the SSW has suggested that Body Dysmorphic Disorder might be better conceptualized within the framework of OCD. There is active discussion about the contours of Conversion disorder, but no recommendations have yet been made.