Somatic symptom disorder E029

ICD Body System

Date amended:

14 Jul 2022

External

Statements of Principles

Current RMA Instruments

Reasonable Hypothesis SOP	64 of 2022
Balance of Probabilities SOP	65 of 2022

Changes from previous Instruments

ICD Coding

ICD-10-AM Code: F45.1

Brief description

This is a DSM-5 psychiatric disorder which is manifested by somatic symptoms, (e.g. pain), which must result in significant disruption of daily life. The disorder is present when there are somatic symptoms which cause distress and dysfunction which have insufficient medical rather than psychiatric explanation. This diagnosis is not made if the manifestations are considered part of another psychiatric disorder such as depressive disorder or panic disorder.

Confirming the diagnosis

A report from a specialist psychiatrist that conforms with the Repatriation Commission Guidelines for Psychiatric Compensation Claims is required for diagnosis.

Additional (superseded, non DSM-5) diagnoses that may be covered by SOP

Hypochondriasis
Pain disorder
Somatization disorder
Undifferentiated somatoform disorder

Conditions not covered by SOP

Other psychiatric disorders such as major depressive disorder which manifest with somatic symptoms
Illness anxiety disorder^#
Conversion disorder^# (functional neurological symptom disorder)
Psychological factors affecting other medical conditions
Factitious disorder^#
Other specified somatic symptom and related disorder^#
Unspecified somatic symptoms and related disorder^#
Malingering / conscious simulation.

^# Non-SOP condition

Clinical onset

Clinical onset requires the presence of one or more somatic symptoms that cause distress or psychosocial impairment along with excessive thoughts, worrying, or behaviours (time and energy) related to the somatic symptoms or to health concerns.

Clinical worsening

The condition typically has a chronic fluctuating course. Eventual improvement or remission can be expected in a significant proportion of subjects.

Psychiatric somatoform classifications:

With the introduction of the DSM-5 there have been significant changes to the somatoform disorders (now called Somatic symptom and related disorders) with the following being the new categories:

Somatic symptom disorder. New condition in DSM-5.
Illness anxiety disorder (ICD-9 300.7; F45.21). New condition in DSM-5.
Conversion disorder (functional neurological symptom disorder) (ICD-9 ; ICD-10 F44.4-7 )
Psychological factors affecting other medical conditions (ICD-9 316; ICD-10 F54). Previously present in DSM-IV-TR under ‘Other conditions that may be a focus of clinical attention’.
Factitious disorder (ICD-9 300.19; ICD-10 F68.10). Old condition previously in its own chapter of Factitious disorders in DSM-IV-TR but now in somatoform disorder category in DSM-5.
Unspecified somatic symptom and related disorder (ICD-9 300.82; ICD-10 F45.9)
Other specified somatic symptom and related disorder (ICD-9 300.89; ICD-10 F45.8):
- Brief somatic symptom disorder
- Brief illness anxiety disorder
- Illness anxiety disorder without excessive health-related behaviours
- Pseudocyesis

The correlation with the previous DSM-IV-TR is imprecise, but the following is provided as a suggested guide (American Psychiatric Association, 2013, ‘Highlights of changes from DSM-IV-TR to DSM-5’, http://www.dsm5.org/Documents/changes%20from%20ds…)

DSM-IV-TR	DSM-5
Conversion disorder (ICD-9 ; ICD-10 F44.4-7 )	Conversion disorder (functional neurological symptom disorder)
Somatization disorder (ICD-9 300.81; ICD-10 F45.0)	Somatic symptom disorder (ICD-9 300.82; ICD-10 F45.1)
Undifferentiated Somatoform disorder (ICD-9 300.82; ICD-10 F45.1)	Somatic symptom disorder (ICD-9 300.82; ICD-10 F45.1)
Pain Disorder associated with psychological factors (ICD-9 307.80; ICD-10 F45.4) AND Pain Disorder associated with psychological factors and a general medical condition (ICD-9 307.89; ICD-10 F45.4)	Somatic symptom disorder (ICD-9 300.82; ICD-10 F45.1) OR Psychological factors affecting other medical conditions (ICD-9 316; ICD-10 F54)
Hypochondriasis (ICD-9 300.7; ICD-10 F45.2)	Somatic symptom disorder (ICD-9 300.82; ICD-10 F45.1) OR Illness anxiety disorder (ICD-9 300.7; F45.21)
Body dysmorphic disorder (ICD-9 300.7; ICD-10 F45.22)	Body dysmorphic disorder (ICD-9 300.7; ICD-10 F45.22) – No longer in the Somatoform disorder classification, but in obsessive compulsive and related disorders.
Somatoform disorder not otherwise specified (ICD-9 300.82; ICD-10 F45.9)	Unspecified somatic symptom and related disorder (ICD-9 300.82; ICD-10 F45.9)
	Other specified somatic symptom and related disorder (ICD-9 300.89; ICD-10 F45.8) - Brief somatic symptom disorder Brief illness anxiety disorder Illness anxiety disorder without excessive health-related behaviours Pseudocyesis
Factitious disorder (ICD-9 300.19; ICD-10 F68.10)	Factitious disorder (ICD-9 300.19; ICD-10 F68.10)

Note that Conscious simulation/Malingering (ICD-9 V65.2; ICD-10 Z76.5) is present in both the DSM-IV-TR and DSM-5 but not as a mental condition but a condition that may be a focus of clinical attention.