Hani hamed dessoki, dsm 5 somatic symptoms


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Hani hamed dessoki, dsm 5 somatic symptoms

  1. 1. Changes from DSM-IV-TR to DSM-5 Dr. Hani Hamed Dessoki, M.D.Psychiatry Prof. Psychiatry Chairman of Psychiatry Department Beni Suef University Supervisor of Psychiatry Department El-Fayoum University APA member
  2. 2. Somatoform disorders Somatic symptom and related disorders
  3. 3. Somatic Symptom Disorders Joel E. Dimsdale, M.D. Chair James L. Levenson, M.D., Text Coordinator Michael R. Irwin, M.D. Francis J. Keefe, Ph.D. (2007-2011) Arthur J. Barsky III, M.D. Sing Lee, M.D. Francis Creed, M.D. Michael Sharpe, M.D. Nancy Frasure-Smith, Ph.D. (2007-2011) Lawson R. Wulsin, M.D.
  4. 4. Somatic symptom and related disorders Somatoform disorders are now called somatic symptom and related disorders. In DSM-IV, there was significant overlap across the somatoform disorders and a lack of clarity about their boundaries. These disorders are primarily seen in medical settings, and nonpsychiatric physicians found the DSM-IV somatoform diagnoses problematic to use.
  5. 5. Somatic symptom and related disorders The DSM-5 classification reduces the number of these disorders and subcategories to avoid problematic overlap. Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed.
  6. 6. Somatic Symptom Disorder The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms. DSM-5 criteria for somatic symptom disorder includes the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.
  7. 7. Somatic Symptom Disorder In DSM-IV, the diagnosis undifferentiated somatoform disorder did not prove to be a useful clinical diagnosis. The distinction between somatization disorder and undifferentiated somatoform disorder was arbitrary.
  8. 8. Somatic Symptom and Related Disorders (161) 300.82 (F45.1)Somatic Symptom Disorder (161) Specify if: With predominant pain Specify if: Persistent Specify current severity: Mild, Moderate, Severe
  9. 9. Medically Unexplained Symptoms The DSM-5 classification defines disorders on the basis of positive symptoms (i.e., distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms). Medically unexplained symptoms do remain a key feature in conversion disorder and pseudocyesis.
  10. 10. Hypochondriasis and Illness Anxiety Disorder J02 In DSM-5, individuals with high health anxiety without somatic symptoms would receive a diagnosis of illness anxiety disorder (unless their health anxiety was better explained by a primary anxiety disorder, such as generalized anxiety disorder). Specify whether: Care seeking type, Care avoidant type
  11. 11. Somatic symptom and related disorders In DSM-5, people with chronic pain can be diagnosed with somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder.
  12. 12. Psychological Factors Affecting Other Medical Conditions and Factitious Disorder  Psychological factors affecting other medical conditions is a new mental disorder in DSM-5, having formerly been included in the DSM-IV chapter “Other Conditions That May Be a Focus of Clinical Attention.” Specify current severity: Mild, Moderate, Severe, Extreme
  13. 13. Conversion Disorder (Functional Neurological Symptom Disorder) J03 Criteria for conversion disorder (functional neurological symptom disorder) are modified to emphasize the essential importance of the neurological examination, and in recognition that relevant psychological factors may not be demonstrable at the time of diagnosis.
  14. 14. Conversion Disorder (Functional Neurological Symptom Disorder) (163)  Specify symptom type: (F44.4)With weakness or paralysis (F44.4)With abnormal movement (F44.4)With swallowing symptoms (F44.4)With speech symptom (F44.5)With attacks or seizures (F44.6)With anesthesia or sensory loss (F44.6)With special sensory symptom (F44.7)With mixed symptoms Specify if: Acute episode, Persistent Specify if: With psychological stressor (specifystressor), Without psychological stressor
  15. 15. Specific Changes Per Diagnostic Category in DSM-5 Obsessive-Compulsive and Related Disorders OCD is now a stand alone category Body Dysmorphic Disorder listed under OCD as F01 Added Hoarding under category of OCD as F02 Trichotillomania now called Hair-Pulling Disorder is listed under OCD as F03 Skin Picking Disorder moved under OCD as F04
  16. 16. Factitious Disorder 300.19 Factitious Disorder (includes Factitious Disorder Imposed on Self, Factitious Disorder Imposed on Another) (165) Specify Single episode, Recurrent episodes
  17. 17. More radical criticisms The extremely high rates of comorbidity (ranging from dimensional diagnosis to various forms of etiopathogenetic diagnosis). The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest. Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.