Chapter 7 - Diagnostic and Statistical Manual of Mental Disorders and Pain Management

Abstract

The classification scheme for psychiatric diagnoses and related pain complaints has changed significantly in the most recent update to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. This general category is now referred to as somatic symptom and related disorders, previously classified as somatoform disorders. This reorganization of diagnoses came about as these patients typically present to primary care providers and other physicians (including pain specialists) and less often to psychiatrists or psychologists. The previous classification scheme was often difficult to interpret and apply for the bulk of nonpsychiatry trained clinicians. Therefore the authors of the DSM-5 sought to reduce the total number of diagnoses in this category and eliminated many of the subdiagnoses. These disorders share somatic symptoms associated with significant distress and functional impairment. Additionally, in the DSM-IV there was a focus on unexplained medical symptoms, whereas the DSM-5 recognizes that somatic symptoms and disorders may actually coexist with diagnosed medical conditions and that psychiatric disorders can be present alongside medical conditions. The DSM-5 also seeks to reduce the negative connotation of the lack of a medical diagnosis or diagnosis of exclusion and therefore shifts focus to presence of positive symptoms. The diagnoses under this heading that generally involve some aspect of pain will therefore be discussed in more detail in this chapter, include somatic symptom disorder, conversion disorder, and factitious disorder. In addition to these diagnoses, the topic of malingering (not classified as a mental illness) will be discussed.