Somatization disorder

1. There must be a history of at least 2 years' complaints of multiple and variable physical symptoms that cannot be explained by any detectable physical disorders. (Any physical disorders that are known to be present do not explain the severity, extent, variety, and persistence of the physical complaints, or the associated social disability.) If some symptoms clearly due to autonomic arousal are present, they are not a major feature of the disorder in that they are not particularly persistent or distressing.
2. Preoccupation with the symptoms causes persistent distress and leads the patient to seek repeated (three or more) consultations or sets of investigations with either primary care or specialist doctors. In the absence of medical services within either the financial or physical reach of the patient, there must be persistent self-medication or multiple consultations with local healers.
3. There is persistent refusal to accept medical reassurance that there is no adequate physical cause for the physical symptoms. (Short-term acceptance of such reassurance, i.e., for a few weeks during or immediately after investigations, does not exclude this diagnosis.)
4. There must be a total of six or more symptoms from the following list, with symptoms occurring in at least two separate groups:
   Gastrointestinal symptoms
   1. abdominal pain;
   2. nausea;
   3. feeling bloated or full of gas;
   4. bad taste in mouth, or excessively coated tongue;
   5. complaints of vomiting or regurgitation of food;
   6. complaints of frequent and loose bowel motions or discharge of fluids from anus;
   Cardiovascular symptoms
   1. breathlessness without exertion;
   2. chest pains;
   Genitourinary symptoms
   1. dysuria or complaints of frequency of micturition;
   2. unpleasant sensations in or around the genitals;
   3. complaints of unusual or copious vaginal discharge;
   Skin and pain symptoms
   1. blotchiness or discoloration of the skin;
   2. pain in the limbs, extremities, or joints;
   3. unpleasant numbness or tingling sensations.
5. Most commonly used exclusion clause. Symptoms do not occur only during any of the schizophrenic or related disorders, any of the mood [affective] disorders, or panic disorder.

Undifferentiated somatoform disorder

1. Criteria A, C, and E for somatization disorder are met, except that the duration of the disorder is at least 6 months.
2. One or both of Criteria B and D for somatization disorder are incompletely fulfilled.

Hypochondriacal disorder

1. Either of the following must be present:
   1. a persistent belief, of at least 5 months' duration, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient);
   2. a persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder).
2. Preoccupation with the belief and the symptoms cause persistent distress or interference with personal functioning in daily living and leads the patient to seek medical treatment or investigations (or equivalent help from local healers).
3. There is persistent refusal to accept medical reassurance that there is no physical cause for the symptoms or physical abnormality. (Short-term acceptance of such reassurance, i.e., for a few weeks during or immediately after investigations, does not exclude this diagnosis.)
4. Most commonly used exclusion clause. The symptoms do not occur only during any of the schizophrenic and related disorders or any of the mood [affective] disorders.

Somatoform autonomic dysfunction

1. There must be symptoms of autonomic arousal that are attributed by the patient to a physical disorder of one or more of the following systems or organs:
   1. heart and cardiovascular system;
   2. upper gastrointestinal tract (esophagus and stomach);
   3. lower gastrointestinal tract;
   4. respiratory system;
   5. genitourinary system.
2. Two or more of the following autonomic symptoms must be present:
   1. palpitations;
   2. sweating (hot or cold);
   3. dry mouth;
   4. flushing or blushing;
   5. epigastric discomfort, “butterflies,” or churning in the stomach.
3. One or more of the following symptoms must be present:
   1. chest pains or discomfort in and around the precordium;
   2. dyspnea or hyperventilation;
   3. excessive tiredness on mild exertion;
   4. aerophagy, hiccough, or burning sensations in chest or epigastrium;
   5. reported frequent bowel movements;
   6. increased frequency of micturition or dysuria;
   7. feeling of being bloated, distended, or heavy.
4. There is no evidence of a disturbance of structure or function in the organs or systems about which the patient is concerned.
5. Most commonly used exclusion clause. These symptoms do not occur only in the presence of phobic disorders or panic disorder.
   A fifth character is to be used to classify the individual disorders in this group, indicating the organ or system regarded by the patient as the origin of the symptoms:
   Heart and cardiovascular system
   Includes: cardiac neurosis, neurocirculatory asthenia, da Costa's syndrome.
   Upper gastrointestinal tract
   Includes: psychogenic aerophagy, hiccough, gastric neurosis.
   Lower gastrointestinal tract
   Includes: psychogenic irritable bowel syndrome, psychogenic diarrhea, gas syndrome.
   Respiratory system
   Includes: hyperventilation.
   Genitourinary system
   Includes: psychogenic increase of frequency of micturition and dysuria.
   Other organ or system

Persistent somatoform pain disorder

1. There is persistent severe and distressing pain (for at least 6 months, and continuously on most days), in any part of the body, which cannot be explained adequately by evidence of a physiological process or a physical disorder and which is consistently the main focus of the patient's attention.
2. Most commonly used exclusion clause. This disorder does not occur in the presence of schizophrenia or related disorders, or only during any of the mood [affective] disorders, somatization disorder, undifferentiated somatoform disorder, or hypochondriacal disorder.

Other somatoform disorders
   In these disorders the presenting complaints are not mediated through the autonomic nervous system, and are limited to specific systems or parts of the body, such as the skin. This is in contrast to the multiple and often changing complaints of the origin of symptoms and distress found in somatization disorder and undifferentiated somatoform disorder. Tissue damage is not involved. Any other disorder of sensation not due to physical disorder, which are closely associated in time with stressful events or problems, or which result in significantly increased attention for the patient, either personal or medical, should also be classified here.
Somatoform disorder, unspecified