Report of the DSM-V Somatic Distress Disorders Work Group
November 2008
Joel Dimsdale, M.D.
The Somatic Distress Disorders Work Group has focused on the following themes:
1. Identification of external advisors and establishing liaisons with other work groups. Because of the prominence of somatic distress disorders in non-psychiatric settings, our work group has sought advisors from additional fields of medicine such as primary care, pediatrics, and neurology. Because of potential overlap with other disorders, we have sought liaisons with other work groups in the areas of mood disorders, personality disorders, childhood/adolescent disorders, and anxiety disorders. We have also had interactions with some of the cross-cutting study groups, particularly the psychiatric general medical interface and the lifespan developmental groups. It is our intention to utilize these advisors and liaisons more heavily once our general rubric of disorders (see item #3 below) is more established.
2. Development of data analysis proposals. One of the challenging issues in reviewing evidence on somatic distress is that somatic distress disorders are rarely considered by psychiatric epidemiology. As a result, the work group has proposed a number of small data analysis projects, with the goal of informing issues such as: the relationship between hypochondriasis and OCD; comorbidities in conversion disorder; the prevalence of somatoform disorders as determined from insurance claims; the relationship of pain disorders to global functioning and axis I disorders; reports from psychiatrists and primary care physicians regarding potential underuse of these diagnostic codes; and dimensional approaches as applied to somatic distress.
3. Developing a draft schema for organizing somatic distress disorders. The group is considering a restructured diagnostic grouping for DSM-V under the general rubric of “Somatic Symptom Disorders.” The latter would include Psychological Factors Adversely Affecting General Medical Conditions, Complex Somatic Symptom Disorders (which groups together somatization disorder, undifferentiated somatoform disorder, hypochondriasis, pain disorder, and neurasthenia), Factitious Disorder, and Functional Neurologic Symptoms/Conversion Disorder. The group is also considering the utility of an Acute Somatic Symptom Disorder—either as part of the Somatic Symptom Disorder rubric or perhaps covered as a variant of Adjustment Disorders. Body Dysmorphic Disorder is being addressed primarily by another work group.