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Psychosomatic Illness (Somatoform Disorders): Diagnosis

Diagnosis

Somatoform Disorder must be distinguished from two other diagnoses: Malingering and Factitious Disorder, which are both characterized by consciously or purposely produced symptoms. Among the criteria specified in the Diagnostic and Statistical Manual – IV (DSM- IV) for a diagnosis of Somatoform Disorder, the person must demonstrate a pattern of recurring, multiple, clinically significant physical complaints, the symptoms of which are NOT produced voluntarily.

Types of Somatoform Disorders diagnosed in children (as specified in DSM IV)

  • Conversion Disorder is the most common type diagnosed in children (see the description of Ania above). Conversion Disorder involves unexplained symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition. The symptoms resemble neurological conditions and physical ailments with organic cause such as blindness, seizures, gait imbalance, paralysis, tunnel vision and numbness. Children may complain of weakness; they may have trouble walking, talking, or hearing. Trauma and abuse increase the likelihood of Conversion Disorder, which is usually triggered by psychological factors.

  • Somatization Disorder is a polysymptomatic disorder that begins before age 30 years, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual and pseudoneurological symptoms. This chronic, recurrent disorder with multiple complaints is often presented in a dramatic and exaggerated way. It is difficult to diagnose in children because of the criteria regarding sexual symptoms.

  • Body Dysmorphic Disorder is the preoccupation with an imagined or exaggerated defect in physical appearance.

  • Hypochondriasis is the preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms or bodily functions.

  • Pain Disorder has limited usefulness in children since there are few studies to distinguish it from Conversion Disorder. Pain Disorder is characterized by pain as the predominant focus of clinical attention. In addition, psychological factors are judged to have an important role in onset, severity, exacerbation, or maintenance.

  • Undifferentiated Somatoform Disorder is characterized by unexplained physical complaints, lasting at least 6 months, that are below the threshold for a diagnosis of Somatization Disorder. When somatoform symptoms do not meet the criteria for any of the specific Somatoform Disorders, a diagnosis of Somatoform Disorder Not Otherwise Specified is utilized.