Editorial
The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV—a preliminary report

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Introduction

This editorial is being written to update colleagues on DSM-V discussions concerning proposed changes to the DSM-IV chapter “Somatoform Disorders.” One suggestion is to rename the chapter “Somatic Symptom Disorders.” The change of title is mirrored by a proposal to substantially recast the constituent diagnoses.

An overview of the DSM-V process has been published elsewhere [1], [2]. An important aspect of this process is the collaboration between the American Psychiatric Association (APA) and the US National Institute of Mental Health (NIMH) to expand the scientific basis for psychiatric classification and diagnosis [1]. This multiyear effort at refining psychiatric diagnoses embraces both the basic sciences relevant to the etiology of psychiatric disorders and the public health implications of the classification including issues relating to gender, culture, life span, and the psychiatric/general medical interface. There is also a strong move to develop dimensional approaches to diagnosis as well as categorical ones [3].

The APA wishes to disseminate widely the information and research recommendations generated by the DSM-V workgroups in order to work toward a unified international system for classification of mental disorders. This requires feedback from a wide spectrum of clinicians and researchers on the deliberations of the workgroups, and feedback is invited on the APA website.1 The workgroup would be grateful for comments on this provisional document, which should be considered a work in progress. Given that the International Classification of Disease (ICD-10) is also in the process of revision, feedback from colleagues around the world is desired. To this end, we present here a summary of how the Somatic Symptom Disorders workgroup and its various advisors are considering these issues.

Section snippets

Concerns about DSM-IV somatoform disorders

The particular issues facing the Somatic Symptom Disorders workgroup have been presented previously [4]. There has been widespread criticism of some aspects of the “Somatoform Disorders” chapter in DSM-IV, expressed both at the APA/NIMH special conference [5] and elsewhere [6], [7], [8]. Some of the main criticisms concern the terms used in the “Somatoform” chapter of DSM-IV, which have been described as unacceptable to patients and incomprehensible to primary care doctors who see the bulk of

Overview of somatic symptom disorders

In the present draft, the DSM-V workgroup have described these disorders as a group of disorders that is characterized predominantly by somatic symptoms resulting in significant distress or dysfunction. These disorders typically present first in nonpsychiatric settings. Psychosocial factors may initiate, exacerbate, or maintain these symptoms. Somatic symptoms are multiply determined and are common in everyday life. These disorders may accompany diverse general medical as well as psychiatric

Psychological factor affecting general medical condition

Some authors have recommended wider use of this category as it is a diagnosis that encompasses the interface between psychiatric and general medical disorders [6]. It has also been stated that this diagnosis has been underused because of the dichotomy, inherent in the “Somatoform” section of DSM-IV, between disorders based on medically unexplained symptoms and patients with organic disease; in the latter, the concepts of somatization, hypochondriasis, etc, were not seen as relevant [15]. By

Conclusion

The current structure of the somatic symptoms disorder disorders proposed for DSM-V differs considerably from that of the somatoform disorders in DSM-IV. This article gives an indication of a likely new structure, but much remains to be done before this is finalized. The next steps include a series of field trials of the new diagnoses, defining the criteria for disorders, and the relevant dimensions which may be used and close coordination with other chapters of DSM-V. One aspect of field

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Members of the Somatic Symptom Disorders workgroup for DSM-V. Joel Dimsdale (Chair), Arthur J. Barsky, Francis Creed, Nancy Frasure-Smith, Michael R. Irwin, Frank Keefe, Sing Lee, James L. Levenson, Michael Sharpe, Lawson R. Wulsin, Javier Escobar.

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