Somatoform Disorders: Pain, Hypochondria, and Body Dysmorphia

Pain Disorder (F45.4)

Diagnostic Criteria

• A. The main clinical symptom is localized pain in one or more areas of the body, of sufficient severity to warrant medical attention.
• B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• E. The pain is not better accounted for by the presence of a mood disorder, an anxiety disorder, or a psychotic disorder and does not meet the criteria for dyspareunia.

Subtypes and Coding

Code as follows:

Pain Disorder Associated with Psychological Factors (307.80)

It is thought that psychological factors play an important role in the onset, severity, exacerbation, or persistence of pain. If there is a medical condition, it does not play an important role in the onset, severity, exacerbation, or persistence of pain. This type of pain disorder is not diagnosed if criteria are also met for somatization disorder.

Pain Disorder with Psychological and Medical Factors (307.89)

Both the psychological and medical conditions play an important role in the onset, severity, exacerbation, or persistence of pain. The associated medical and anatomical location (see below) are coded on Axis III.

Specifiers for Pain Disorder

Specify (for both) if:

• Acute: Duration of less than six months.
• Chronic: Duration of six months or more.

Hypochondria (F45.2 / 300.7)

Diagnostic Criteria

• A. Preoccupation with fears of having, or the idea of developing, a serious disease based on personal interpretations of somatic symptoms.
• B. The preoccupation persists despite appropriate medical evaluation and reassurance.
• C. The belief in Criterion A is not of delusional intensity (as opposed to delusional disorder, somatic type) and is not limited to concerns about appearance (as opposed to body dysmorphic disorder).
• E. The duration of the disorder is at least six months.
• F. The preoccupation is not better accounted for by the presence of generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, major depressive episode, separation anxiety, or other somatoform disorder.

Specifier: With Poor Insight

If, during the greater part of the episode, the person does not realize that the concern for suffering a serious illness is excessive or unreasonable.

Body Dysmorphic Disorder (F45.2 / 300.7)

Criteria for the Diagnosis

• A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is excessive.
• B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).