2. 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

3. Somatoform disorders
Somatic symptom and related
disorders

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. 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.

11. 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

12. 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.

13. 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

14. 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.

15. 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

16. 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

17. Factitious Disorder 300.19
Factitious Disorder (includes Factitious Disorder
Imposed on Self,
Factitious Disorder Imposed on Another) (165)
Specify Single episode,
Recurrent episodes

18. 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.