1. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.
2. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:
   1. four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)
   2. two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)
   3. one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)
   4. one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)
3. Either (1) or (2):
   1. after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)
   2. when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings
4. The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).

1. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.
2. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
3. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
4. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.
5. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
6. 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.

Specify type of symptom or deficit:
With motor symptom or deficit
With sensory symptom or deficit
With seizures or convulsions
With mixed presentation

1. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
2. The preoccupation persists despite appropriate medical evaluation and reassurance.
3. The belief in Criterion A is not of delusional intensity (as in delusional disorder, somatic type) and is not restricted to a circumscribed concern about appearance (as in body dysmorphic disorder).
4. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
5. The duration of the disturbance is at least 6 months.
6. The preoccupation is not better accounted for by generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, a major depressive episode, separation anxiety, or another somatoform disorder.

Specify if:
With poor insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable

1. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).

1. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.
2. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
4. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
5. The pain is not better accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for dyspareunia.

Code as follows:
Pain disorder associated with psychological factors: psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. (If a general medical condition is present, it does not have a major role in the onset, severity, exacerbation, or maintenance of the pain.) This type of pain disorder is not diagnosed if criteria are also met for somatization disorder.
Specify if:
Acute: duration of less than 6 months
Chronic: duration of 6 months or longer
Pain disorder associated with both psychological factors and a general medical condition: both psychological factors and a general medical condition are judged to have important roles in the onset, severity, exacerbation, or maintenance of the pain. The associated general medical condition or anatomical site of the pain (see below) is coded on Axis III.
Specify if:
Acute: duration of less than 6 months
Chronic: duration of 6 months or longer
Note: The following is not considered to be a mental disorder and is included here to facilitate differential diagnosis.
Pain disorder associated with a general medical condition: a general medical condition has a major role in the onset, severity, exacerbation, or maintenance of the pain. (If psychological factors are present, they are not judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain.) The diagnostic code for the pain is selected based on the associated general medical condition if one has been established or on the anatomical location of the pain if the underlying general medical condition is not yet clearly established—for example, low back, sciatic, pelvic, headache, facial, chest, joint, bone, abdominal, breast, renal, ear, eye, throat, tooth, and urinary.

1. One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints).
2. Either (1) or (2):
   1. after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)
   2. when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The duration of the disturbance is at least 6 months.
5. The disturbance is not better accounted for by another mental disorder (e.g., another somatoform disorder, sexual dysfunction, mood disorder, anxiety disorder, sleep disorder, or psychotic disorder).
6. The symptom is not intentionally produced or feigned (as in factitious disorder or malingering).

This category includes disorders with somatoform symptoms that do not meet the criteria for any specific somatoform disorder. Examples include

1. Pseudocyesis: a false belief of being pregnant that is associated with objective signs of pregnancy, which may include abdominal enlargement (although the umbilicus does not become everted), reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorgement and secretions, and labor pains at the expected date of delivery. Endocrine changes may be present, but the syndrome cannot be explained by a general medical condition that causes endocrine changes (e.g., a hormone-secreting tumor).
2. A disorder involving nonpsychotic hypochondriacal symptoms of less than 6 months' duration.
3. A disorder involving unexplained physical complaints (e.g., fatigue or body weakness) of less than 6 months' duration that are not due to another mental disorder.