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Chapter V

Somatoform disorders - F45


The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient.
    Excludes:
  • dissociative disorders ( F44.- )
  • hair-plucking ( F98.4 )
  • lalling ( F80.0 )
  • lisping ( F80.8 )
  • nail-biting ( F98.8 )
  • psychological or behavioural factors associated with disorders or diseases classified elsewhere ( F54 )
  • sexual dysfunction, not caused by organic disorder or disease ( F52.- )
  • thumb-sucking ( F98.8 )
  • tic disorders (in childhood and adolescence) ( F95.- )
  • Tourette's syndrome ( F95.2 )
  • trichotillomania ( F63.3 )
F45.0 Somatization disorder
The main features are multiple, recurrent and frequently changing physical symptoms of at least two years' duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour. Short-lived (less than two years) and less striking symptom patterns should be classified under undifferentiated somatoform disorder (F45.1).
Briquet's disorder
Multiple psychosomatic disorder
    Excludes:
  • malingering [conscious simulation] ( Z76.5 )
F45.1 Undifferentiated somatoform disorder
When somatoform complaints are multiple, varying and persistent, but the complete and typical clinical picture of somatization disorder is not fulfilled, the diagnosis of undifferentiated somatoform disorder should be considered.
Undifferentiated psychosomatic disorder
F45.2 Hypochondriacal disorder
The essential feature is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders. Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often interpreted by patients as abnormal and distressing, and attention is usually focused upon only one or two organs or systems of the body. Marked depression and anxiety are often present, and may justify additional diagnoses.
Body dysmorphic disorder
Dysmorphophobia (nondelusional)
Hypochondriacal neurosis
Hypochondriasis
Nosophobia
    Excludes:
  • delusional dysmorphophobia ( F22.8 )
  • fixed delusions about bodily functions or shape ( F22.- )
F45.3 Somatoform autonomic dysfunction
Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient to a specific organ or system.
Cardiac neurosis
Da Costa's syndrome
Gastric neurosis
Neurocirculatory asthenia
Psychogenic forms of:
  • aerophagy
  • cough
  • diarrhoea
  • dyspepsia
  • dysuria
  • flatulence
  • hiccough
  • hyperventilation
  • increased frequency of micturition
  • irritable bowel syndrome
  • pylorospasm
      Excludes:
    • psychological and behavioural factors associated with disorders or diseases classified elsewhere ( F54 )
  • F45.4 Persistent somatoform pain disorder
    The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder, and which occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical. Pain presumed to be of psychogenic origin occurring during the course of depressive disorders or schizophrenia should not be included here.
    Psychalgia
    Psychogenic:
  • backache
  • headache
    Somatoform pain disorder
      Excludes:
    • backache NOS ( M54.9 )
    • pain:
    • NOS ( R52.9 )
    • acute ( R52.0 )
    • chronic ( R52.2 )
    • intractable ( R52.1 )
    • tension headache ( G44.2 )
  • F45.8 Other somatoform disorders
    Any other disorders of sensation, function and behaviour, not due to physical disorders, which are not mediated through the autonomic nervous system, which are limited to specific systems or parts of the body, and which are closely associated in time with stressful events or problems.
    Psychogenic:
  • dysmenorrhoea
  • dysphagia, including "globus hystericus"
  • pruritus
  • torticollis
    Teeth-grinding
  • F45.9 Somatoform disorder, unspecified
    Psychosomatic disorder NOS


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