Skip Navigation LinksHome / Proposed Revisions / Proposed Revision

316
Psychological Symptoms Affecting Medical Condition

The work group is recommending that this subtype not be included in DSM-5.

Please see the proposed criteria for Psychological Factors Affecting Medical Condition.

Please see full disorder descriptions here.

 

Major change #1: Rename Somatoform disorders to Somatic Symptom Disorders and combine with PFAMC and Factitious Disorders

The workgroup suggests combining Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders into one group entitled “Somatic Symptom Disorders” because the common feature of these disorders is the central place in the clinical presentation of physical symptoms and/or concern about medical illness. The grouping of these disorders in a single section is based on clinical utility (these patients are mainly encountered in general medical settings), rather than assumptions regarding shared etiology or mechanism.

 

Major change #2: De-emphasize medically unexplained symptoms

Remove the language concerning medically unexplained symptoms for reasons specified above. The reliability of such judgments is low (Rief, 2007). In addition, it is clear that many of these patients do in fact have considerable medical co-morbidity (Creed, Ng). Medically unexplained symptoms are 3 times as common in patients with general medical illnesses, including cancer, cardiovascular and respiratory disease compared to the general population (OR=3.0 [95%CI: 2.1 to 4.2]  (Harter et al 2007). This de-emphasis of medically unexplained symptoms would pertain to somatization disorder, hypochondriasis, undifferentiated somatoform disorder, and pain disorder. We now focus on the extent to which such symptoms result in subjective distress, disturbance, diminished quality of life, and impaired role functioning.

 

Please see the full rationale document here.

Severity

For PFAMC, severity scoring might include “1” when the psychological factor  only increases risk for medical illness, “2” when the symptoms of medical illness are exacerbated, and “3” when the effect is life-threatening.

 

[Specified Psychological Factor] Affecting . . . [Indicate the General Medical Condition]

A. A general medical condition (coded on Axis III) is present.

B. Psychological factors adversely affect the general medical condition in one of the following ways:

(1) the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition

(2) the factors interfere with the treatment of the general medical condition

(3) the factors constitute additional health risks for the individual

(4) stress-related physiological responses precipitate or exacerbate symptoms of the general medical condition

Choose name based on the nature of the psychological factors (if more than one factor is present, indicate the most prominent):

Psychological Symptoms Affecting . . . [Indicate the General Medical Condition] (e.g., depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma)

Participate
New User? Register Now
Forgot Password?
  American Psychiatric Association
 
Skip Navigation LinksHome > Proposed Revisions > Proposed Revision