Somatoform Disorders

Current Debates

“Somatoform Disorders” were defined in the International Classification of Diseases 35 years ago, in the DSM-IV in 1994, and again in the DSM-IV TR in 2000.  In those volumes, “Somatoform Disorders” is a category with a broad definition, and there are six different “somatoform” labels doctors can choose from within that category . . .

  • Hypochondriasis
  • Pain Disorder
  • Somatization Disorder
  • Undifferentiated Somatoform Disorder
  • Body Dysmorphic Disorder
  • Conversion Disorder
  • Somatoform Disorder Not Otherwise Specified

. . . though it is not uncommon for doctors to use the phrase “Somatoform Disorder” in a general way that is described best with the very loose criteria for “Undifferentiated Somatoform Disorder”.

In recent years there has been a consensus that those definitions need to be revised and controversy about the right way to revise them has been heated, to say the least.  The new DSM edition came out in May of 2013 – the “DSM-5” – amid sharp criticism about the proliferation of new mental disorders in general.

The category of “Somatoform Disorders” was revised to “Somatic Symptom and Related Disorders”, with “Somatic Symptom Disorder” taking the place of the first four old labels: “Hypochondriasis”, “Pain disorder”, “Somatization Disorder” and “Undifferentiated Somatoform Disorder”.

Revisions for the ICD-11 are in the works but will not be published till at least 2016.

For those concerned about the problem of denial of care, the new “Somatic Symptom Disorder” is alarming on a number of counts, not the least of which is the decision to go ahead and publish it amid immense resistance and criticism from patient advocacy groups, from within the psychiatric community, and from the public at large.  Proposed changes for the ICD’s upcoming edition are at least equally worrisome, if not more so.

There is no question that Somatic Symptom Disorder and prospects for ICD revisions are a great deal more threatening to patients’ right to available medical care than Somatoform Disorder ever was.  Moreover, it is clear that patients’ rights to full disclosure, informed consent, and autonomy are actually directly targeted in some revisions and proposals for the expressed purpose of making those presumed to have Somatoform Disorders easier to “manage”.

For anyone concerned about the problem of denial of care, the new definitions and proposals are nothing short of alarming.

Still, the Coalition for Diagnostic Rights sees value in the conversation that has begun as a result of the revision process.

  • Every time someone expresses concern about the recklessness of new definitions, they also contribute in a detailed way to our common understanding of what these kinds of diagnoses really amount to.
  • Every time we see what risks we create with a new approach we come closer to understanding exactly how we’ve arrived at where we stand today – how it could possibly have come to seem insignificant to the medical community that most of the 30 million rare disease patients, and almost half of the 50 million US autoimmune disease patients in the US are now mistakenly denied medical care as a matter of course.
  • Every time we disagree about how to revise these diagnostic standards we come closer to really taking in the unfathomable numbers of patients across the globe who suffer without treatment at this very moment for no other reason than that we’ve been reckless about error in Somatoform diagnosis.

In these four Current Debates pages, you will find clarification of recent debates and developments related to the revision of “Somatoform Disorders”, with links all along the way so you can read for yourself what is being summarized here.  We will soon expand these summaries and will continue to update them.  We recognize that our broad overview is in no way comprehensive and sometimes skirts the details for the sake of overall clarity.  As always, the Coalition for Diagnostic Rights welcomes your corrections and suggestions for improvements.

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