Somatoform, Factitious, 

and Dissociative Disorders

Contents of this page:

Conversion Disorder         Somatization Disorder      Undifferentiated Somatoform Disorder

Hypochondriasis       Pain        Body Dysmorphic Disorder

Factitious Disorder

Dissociative Amnesia       Dissociative Fugue        

   Dissociative Identity Disorder          Depersonalization Disorder

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Conversion Disorder

• At least one symptom or deficit of sensory or voluntary motor function suggests a neurological or general medical condition.

• It is not limited to pain or sexual dysfunction.

• Appropriate investigation does not identify a neurological or general medical condition or the direct effects of substance use that can fully explain it.

• Conflicts or other stressors that precede the onset or worsening of this symptom suggest that psychological factors are related to it.

• The patient doesn't consciously feign the symptoms for material gain (Malingering) or to occupy the sick role (Factitious Disorder).

• It is not a culturally sanctioned behavior or experience.

• It is serious enough to produce at least 1 of:
  -warrants medical evaluation, or
  -causes distress that is clinically important, or
  - impairs social, occupational or personal functioning

• It does not occur solely during Somatization Disorder, and no other mental disorder better explains it.

Specify type of symptom or deficit:

     With Motor Symptom or Deficit
     With Seizures or Convulsions
     With Sensory Symptom or Deficit
     With Mixed Presentation

Somatization Disorder

• Starting before age thirty, the patient has had many physical complaints occurring over several years.

• The patient has sought treatment for these symptoms, or they have materially impaired social, work or personal functioning.

• The patient has at some time experienced a total of at least 8 symptoms from the following list, distributed as noted. These symptoms need not be concurrent.
  PAIN SYMPTOMS (4 or more) related to different sites, such as head, abdomen, back, joints, extremities, chest or rectum, or related to body functions such as menstruation, sexual intercourse or urination
  GASTROINTESTINAL SYMPTOMS (2 or more, excluding pain) such as nausea, bloating, vomiting (not during pregnancy), diarrhea, intolerance of several foods
  SEXUAL SYMPTOMS (at least 1, excluding pain) including indifference to sex, difficulties with erection or ejaculation, irregular menses, excessive menstrual bleeding or vomiting throughout all nine months of pregnancy.
  PSEUDONEUROLOGICAL SYMPTOMS (at least 1) including impaired balance or coordination, weak or paralyzed muscles, lump in throat or trouble swallowing, loss of voice, retention of urine, hallucinations, numbness (to touch or pain), double vision, blindness, deafness, seizures, amnesia or other dissociative symptoms, loss of consciousness (other than with fainting). None of these is limited to pain.

• For each of the above symptoms, one of these conditions must be met:
  -Physical or laboratory investigation determines that the symptom cannot be fully explained by a general medical condition or by substance use, including medications and drugs of abuse, or
  -If the patient does have a general medical condition, the impairment or complaints exceed what you would expect, based on history, laboratory findings or physical examination.

• The patient doesn't consciously feign the symptoms for material gain (Malingering) or to occupy the sick role (Factitious Disorder).

Coding Note

In each of the above four symptom categories, the specific symptoms are listed in approximate descending order of frequency.

Undifferentiated Somatoform Disorder

• The patient has at least one physical complaint, such as trouble breathing, chest pain, painful urination, fatigue and so forth.

• For any such symptom to be counted, one of these conditions must be met:
  -Physical or laboratory investigation determines that the symptom cannot be fully explained by a general medical condition or by substance use, including medications and drugs of abuse, or
  -If the patient does have a general medical condition, the impairment or complaints exceed what you would expect, based on history, laboratory findings or physical examination.

• The symptoms cause clinically important distress or impair work, social or personal functioning.

• This condition has lasted 6 months or longer.

• It isn't better explained by another mental disorder such as Psychotic, Mood, Anxiety, Somatoform or Sleep Disorder or a Sexual Dysfunction.

• The patient doesn't consciously feign the symptoms for material gain (Malingering) or to occupy the sick role (Factitious Disorder).

Hypochondriasis

• Because of misinterpreting bodily symptoms, the patient becomes preoccupied with ideas or fears of having a serious illness.

• Appropriate medical investigation and reassurance do not relieve these ideas.

• These ideas are not delusional (as in Delusional Disorder) and are not restricted to concern about appearance (as in Body Dysmorphic Disorder).

• They cause distress that is clinically important or impair work, social or personal functioning.

• They have lasted 6 months or longer.

• These ideas are do better explained by Generalized Anxiety Disorder, Major Depressive Episode, Obsessive-Compulsive Disorder, Panic Disorder, Separation Anxiety or a different Somatoform Disorder.

Specify when With Poor Insight: During most of this episode, the patient does not realize that the preoccupation is excessive or unreasonable.

Pain Disorder

• The patient's presenting problem is clinically important pain in one or more body areas.

• The pain causes distress that is clinically important or impairs work, social or personal functioning.

• Psychological factors seem important in the onset, maintenance, severity or worsening of the pain.

• Other Disorders (Mood, Anxiety, Psychotic) do not explain the symptoms better, and the patient does not meet criteria for Dyspareunia.

• The patient doesn't consciously feign the symptoms for material gain (Malingering) or to occupy the sick role (Factitious Disorder).

Code According to the predominant cause of pain:

307.80 Pain Disorder Associated with Psychological Factors. If a general medical condition is present, it does not play the major role in the cause, maintenance, severity or worsening of the pain. Do not use this code if the patient also meets criteria for Somatization Disorder.

307.89 Pain Disorder Associated with Both Psychological Factors and a General Medical Condition.* Both of these factors seem important in the onset, maintenance, severity or worsening of the pain.

For either of above, specify whether:

     Acute. Has lasted less than 6 months
     Chronic. Has lasted 6 months or longer

Coding Notes

*Also code the general medical condition or site of the pain on Axis III, if the diagnosis is Pain Disorder Associated with Both Psychological Factors and a General Medical Condition. The site is coded only if the exact general medical condition is not yet known. The following Axis III code numbers for site of pain are included for your convenience:

Coding Note

Pain Disorder Associated with a General Medical Condition. This term is used for any patient who has pain that is mainly caused, worsened or maintained by a general medical condition, so long as any psychological factors play at most a minor role. This is not considered to be a mental disorder and is coded only on Axis III. Code numbers for site are as above. For example:

Axis III 784.0 Pain Disorder Associated with Facial Pain

Body Dysmorphic Disorder

• The patient is preoccupied with an imagined defect of appearance or is excessively concerned about a slight physical anomaly.

• This preoccupation causes clinically important distress or impairs work, social or personal functioning.

• Another mental disorder (such as Anorexia Nervosa) does not better explain the preoccupation.

300.81 Somatoform Disorder Not Otherwise Specified

Factitious Disorder

• The patient intentionally feigns physical or mental signs or symptoms.

• The patient's apparent motive for this behavior is to occupy the sick role.

• There are no other motives such as found in Malingering (financial gain, revenge or avoiding legal responsibility).

Code based on predominant symptom:

300.16 With Predominantly Psychological Signs and Symptoms

300.19 With Predominantly Physical Signs and Symptoms

300.19 With Combined Psychological and Physical Signs and Symptoms. (Neither predominates.)

Dissociative Disorders

Dissociative Amnesia

• The patient's main problem is at least one episode of inability to recall important personal information. This information usually concerns trauma or stress, and it is more extensive than could be explained by common forgetfulness.

• These symptoms cause clinically important distress or impair work, social or personal functioning.

• It does not occur solely during Dissociative Identity Disorder, Dissociative Fugue Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder or Somatization Disorder.

• The symptoms are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.

Dissociative Fugue

• The main problem is that the patient suddenly and unexpectedly travels from home or usual workplace and cannot recall personal history.

• The patient may be confused about identity or assume a new identity; these can be partial or complete.

• These symptoms do no occur solely as a part of Dissociative Identity Disorder.

• They are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.

• They cause clinically important distress or impair work, social or personal functioning.

Dissociative Identity Disorder

• The patient has at least two distinct identities or personality states. Each of these has its own, relatively lasting pattern of sensing, thinking about and relating to self and environment.

• At least two of these personalities repeatedly assume control of the patient's behavior.

• Common forgetfulness cannot explain the patient's extensive inability to remember important personal information.

• This behavior is not directly caused by substance use (such as alcoholic blackouts) or by a general medical condition.

Coding Note

In children, the symptoms cannot be attributed to fantasy play, including imaginary playmates.

Depersonalization Disorder

• There is a lasting or recurring feeling of being detached from the patient's own body. The patient feels like an outside self-observer, as if in a dream.

• Throughout the experience, the patient knows this is not really the case (reality testing is intact).

• This phenomenon causes clinically important distress or impairs work, social or personal functioning.

• This experience doesn't occur solely in the course of another mental disorder such as Acute Stress Disorder, Panic Disorder, Schizophrenia or a different Dissociative Disorder.

• The disorder is not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.

300.15 Dissociative Disorder Not Otherwise Specified

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