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Is the DSM-5 chapter on somatic symptom disorder any better than DSM-IV somatoform disorder?

  • Richard Mayou (a1)
Summary

DSM-5 is a modest improvement on DSM-IV, notably in abandoning the distinction between medically explained and unexplained symptoms, but problems remain. The chapter text is incoherent, contradicts the classification and will be clinically unhelpful. ICD-11 should attempt a more logical and consistent revision.

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References
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1 Mayou, R, Kirmayer, LJ, Simon, G, Kroenke, K, Sharpe, M. Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 2005; 162: 847–55.
2 Sharpe, M, Mayou, R, Walker, J. Bodily symptoms: new approaches to classification. J Psychosom Res 2006; 60: 353–6.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). APA, 1980.
4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
5 Gornall, J. DSM-5: a fatal diagnosis? BMJ 2013; 346: f3256.
6 Sharpe, M. Somatic symtoms: beyond ‘medically unexplained'. Br J Psychiatry 2013; 203: 320–1.
7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
8 Starevic, S. Hypochondriasis and health anxiety: conceptual challenges. Br J Psychiatry 2013; 202: 78.
9 Casey, P, Doherty, A. Adjustment disorder: implications for ICD-11 and DSM-5. Br J Psychiatry 2012; 201: 90–2.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Is the DSM-5 chapter on somatic symptom disorder any better than DSM-IV somatoform disorder?

  • Richard Mayou (a1)
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eLetters

DSM-5 Somatic symptom disorder, is it a leap without looking.

Tarek M. Shahrour, consultant in Liaison psychiatry
11 July 2014

There is clearly a leap of faith in the newly published DSM-5 in comparison with the previous classification system when it comes to the definition of somatic disorders , so much that one can claim that most of the research done on this disorder according to the old definition is going to be redundant. There is a sort of qualitative jump from the old tothe new and we seem, again in psychiatry to have devised a definition of adisorder and then attempt to prove that it does exist! As it is clearly stated in the editorial, the new definition is not based on any new evidence. Therefore, one can claim that our balance of epistemological/ontological direction of knowledge seems to be skewed.

The author indicated that there is a clear overlap with the relatively common clinical entity of adjustment disorder. The latter, is related to the new inherent conceptual change and will most probably provequite tricky to tackle in every day life of a liaison psychiatrist, not to mention other challenges it might pose when including and excluding subjects in future studies.

The other issue is how physicians working in primary care and non-psychiatric specialties will react to this conceptual change of somatic symptom disorders, how are they going to define what is "excessive thoughts feelings or behavior" to treat or make the referral. It seems that the good old fashioned hierarchy is going to be challenged. This change of the practice will most likely take a long time and effort to integrate into everyday practice. The question is; Is change worth the effort ? We are as it i, spending time and effort in order to change old fashioned terms the likes of hysteria into conversion, which has thus far remained strongly entrenched in our minds!

An added dilemma would be if the ICD11did not follow suit. If this happens it will mean that we are going to have another schism between thetwo classifying systems added to the conceptual differences currently present.

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Conflict of interest: None declared

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