Psychiatric Mis-Diagnosis in Pediatric Pain Problems. DSM IV Somatization Disorder. DSM IV Somatization Disorder. Somatization Disorders

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1 Psychiatric Mis-Diagnosis in Pediatric Pain Problems Richard Barnum, M.D. Somatization s Conversion DSM IV Somatization A. A history of many physical complaints beginning before age 30 years, occurring over several years, resulting in seeking treatment, or significant impairment. DSM IV Somatization B. Each one of the following criteria must have been met, with individual symptoms occurring at any time: 1. Four pain symptoms (related to different sites or functions) 2. Two gastrointestinal symptoms (other than pain) 3. One sexual symptom (other than pain) 4. One "pseudoneurological" symptom (not limited to pain) All rights reserved. 1

2 DSM IV Somatization C. Either (1) or (2): 1. after appropriate investigation, each of the symptoms cannot be fully explained by a known general medical condition (GMC) or direct effects of a substance. 2. when there is a related GMC, the physical complaints or resulting impairment are in excess of what would be expected from the history, physical examination, or laboratory findings. DSM IV Somatization D. The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering. DSM Somatic Symptom All rights reserved. 2

3 A. One or more somatic symptoms that is distressing or result in significant disruption to daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one s symptom(s). All rights reserved. 3

4 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of heing symptomatic is persistent (typically more than 6 months). All rights reserved. 4

5 A. One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition. B. Psychological factors are judged to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. C. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering). All rights reserved. 5

6 D. The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience. E. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder. All rights reserved. 6

7 DSM 5 Diagnostic criteria for Conversion ( Functional Neurological Symptom ) DSM 5 Conversion A. One or more symptoms of altered voluntary motor or sensory function. DSM 5 Conversion B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. All rights reserved. 7

8 DSM 5 Conversion C. The symptom or deficit is not better explained by another medical or mental disorder. DSM 5 Conversion D. The symptom or deficit causes clinically significant distress or impairment in social, occupation or other important areas of functioning or warrants medical evaluation. communicating-effectivelyyour-healthcare-providers All rights reserved. 8

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