Somatoform Disorders: Classification

Classification of somatoform disorders (by ICD-10 code).

Designation according to ICD-10 Comparison with DSM-IV* Criteria according to ICD-10
F45.0: somatization disorder1 DSM-IV 300.81: Somatization disorder
  • Multiple symptoms or localization (≥ 6 out of ≥ 2 domains), occurring repeatedly and changing frequently
  • For at least 2 years
  • Course: chronic and fluctuating
  • Frequent disturbances of social, interpersonal and family behavior.
F45.1: Undifferentiated somatization disorder1 DSM-IV 300.82: Undifferentiated somatoform disorder.
  • Numerous physical complaints that are variable and persistent
  • Complete and typical clinical picture of somatization disorder is not met, however
F45.3: Somatoform autonomic dysfunction.

  • F45.30: Cardiac and circulatory system
  • F45.31: Upper digestive system
  • F45.32: Lower digestive system
  • F45.33: Respiratory system
  • F45.34: Genitourinary system
  • F45.37 Multiple organs and systems
  • F45.38: Other organs and systems
  • F45.39: Nicnt specified organ or system
 No equivalent in DSM-IV
  • Description of symptoms is given as if they were based on physical disease of a system or organ largely or completely innervated and controlled by vegetation
  • Two sets of symptoms are usually found, neither of which is indicative of physical disease of the organ or system in question:
    • Objectifiable symptoms of autonomic stimulation – palpitations, flushing, sweating, tremors.
    • Subjective symptoms of non-specific and changing nature – pain, burning, heaviness, tightness, feeling of being bloated; these complaints are attributed by the patient to a specific organ or system
F45.4: Persistent pain disorder 1

  • F45.40: Persistent somatoform pain disorder.
  • F45.41: Chronic pain disorder with somatic and psychological factors
 DSM-IV 307.8X: Pain disorder. Persistent somatoform pain disorder (ICD-10: F45.40).

  • Persistent (≥ 6 months), severe, and excruciating pain that cannot be adequately explained by a physiologic process or physical disorder
  • The pain is not intentionally produced or feigned
  • The pain is associated with emotional conflicts or psychosocial stresses
  • Often considerably increased personal or medical help and support

Chronic pain disorder with somatic and psychological factors (ICD-10: F45.41).

  • Persistent (≥ 6 months) pain in one or more anatomic regions that has its point of origin in a physiologic process or a physical disorder
  • Psychological factors are considered to play an important role in severity, exacerbation (marked worsening of symptoms), or maintenance of pain, but not the causative role in its onset
  • Pain causes clinically significant suffering and impairment in social, occupational, or other important areas of functioning
F45.8/9: Other/unspecified somatoform disorders. DSM-IV 300.82: Unspecified somatoform disorder. Any other disorder of perception, bodily function, or illness behavior that is not mediated by the autonomic nervous system, is limited to specific parts or systems of the body, and is closely associated with stressful events or problems.
F48.0: neurasthenia No equivalent in DSM-IV Two main forms:

  1. Complaining of increased fatigue after mental exertion, often associated with declining work performance or effectiveness in accomplishing daily tasks
  2. Feelings of physical weakness and exhaustion after only minor exertion, accompanied by muscular and other aches and pains and an inability to relax
  • In addition, often other unpleasant physical sensations such as dizziness, tension headache, sleep disturbances, concern about declining mental and physical well-being, irritability, joylessness, depression, and anxiety
  • Considerable cultural differences
F44.4-7: Conversion disorder (dissociative disorders of movement and sensation) 2 (separate ICD-10 category) DSM-IV 300.11: Conversion disorder (assigned to the somatoform disorders chapter).
  • Most commonly, complete or partial loss of the ability to move one or more limbs of the body
  • Great similarity to almost any form of ataxia (gait disorders), apraxia (inability to perform purposeful actions), akinesia (high-grade lack of movement to immobility), aphonia (voiceless), dysarthria (speech disorders), dyskinesia (pathological movements), seizures or paralysis (pseudoneurological symptomatology)
  • Expressive disease A triggering conflict must be recognizable and expressed in the symptom in terms of compromise solution

* Diagnostic and Statistical Manual of Mental Disorders: national classification system in psychiatry (USA).

1 These subtypes are likely to be grouped under the term “complex somatic symptom disorder” in DSM-IV.2 ICD-10 chapter F44.0-3 also lists various “dissociative disorders of consciousness,” such as dissociative fugue (sudden, unexpected, and aimless running away of a person without an objectively ascertainable reason) or dissociative amnesia (formerly psychogenic amnesia/memory lapses). The classification of conversion disorders in DSM-IV has not yet been conclusively determined.