Health ministry of republic of moldova the university of medicine and pharmacy nicolae testemiţanu

 
3. Psychosomatic disorders classification
The American Psychiatric Association (APA) have classified soma-
toform disorders in the DSM-IV and the World Health Organization 
(WHO) have classified these in the ICD-10. Both classification systems 
use similar criteria. Most current practitioners will use one over the other, 
though in cases of borderline diagnoses, both systems may be referred to. 
The somatoform disorders recognized by the 
Diagnostic and Statis-
tical Manual of Mental Disorders (DSM-IV) 
of the American Psychiatric 
Association are: 
–
Somatization disorder. 
–
Conversion disorder. 
–
Hypochondriasis. 
–
Pain disorder. 
–
Body dysmorphic disorder. 
–
Undifferentiated somatoform disorder - only one unexplained 
symptom is required for at least 6 months. 
–
Included among these disorders are false pregnancy, psychogenic 
urinary retention, and mass psychogenic illness (so-called mass hysteria). 
–
Somatoform disorder not otherwise specified (NOS). 
The most frevently diagnosed somatoform disorders are:
–
somatization disorder;
–
conversion disorder; 
–
hypochondriasis 
and 
 

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–
pain disorder.
The clinical signs of them are proposed below.
Somatization Disorder 
DSM-IV states that for a symptom to qualify for somatization 
disorder, it has to be without medical explanation. Some of the nume-
rous symptoms that can occur with somatization disorder include: vomi-
ting; abdominal pain; nausea; bloating; diarrhea; pain in the legs or 
arms; back pain; joint pain; pain during urination; headaches; shortness 
of breath; palpitations; chest pain; dizziness; amnesia; difficulty swal-
lowing; vision changes; paralysis or muscle weakness; sexual apathy; 
pain during intercourse; impotence; painful menstruation and irregular 
menstruation; excessive menstrual bleeding, etc. 
Epidemiology of Somatization Disorder. 
The reports of prevalence 
of somatization disorder depend on the assessment methods used. 
Community surveys have reported prevalence of less than 1% and 
primary care findings have usually been between 1 and 2%. The 
disorder is twice as common in women as in men. Diagnosis is 
considerably less stable over time than suggested in the original des-
criptions of the syndrome. 
 
Treatment of Somatization Disorder. 
Somatization disorder is 
difficult to treat. Continuing care by one doctor using only the minimum 
of essential investigations can reduce the patients' use of health services 
and may improve their functional state.
 
Once other causes have been ruled out and a diagnosis of somatiza-
tion disorder is secured, the goal of treatment is to help the person learn 
to control the symptoms. There is often an underlying mood disorder 
which can respond to conventional treatment, such as antidepressant 
medications.
Regularly scheduled appointments should be maintained to review 
symptoms and the person's coping mechanisms. Test results should be 
explained. 
Psychiatric assessment can help to clarify a complicated history, to 
negotiate a simplified pattern of care and to agree the aims of treatment 
with the patient, the family and the responsible physician. The aim of 
treatment is often to limit further progression rather than to cure.