“Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?

ICD-10 Chapter V “Somatoform Disorders”

This is the section of ICD-10 that corresponds with the current Somatoform Disorders section in DSM-IV.

There is a degree of correspondence between the current category names for this section of ICD-10 and DSM-IV, as set out in this (simplified) table, which lists only category terms and not criteria:

Current DSM-IV Codes and Categories for Somatoform Disorders and ICD-10 Chapter V Equivalents

[Note: Neurasthenia is not categorized in DSM-IV.]

Source: Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiat. 2005;162:847–855.

You can view category descriptions for ICD-10 Somatoform Disorders in the ICD-10 Tabular List on this page of the Online Version: 2010: ICD-10 Somatoform Disorders (F45)

For the full Somatoform Disorders disorder descriptions see Page 129 of this free ICD-10 PDF:
ICD-10 for Mental and Behavioural Disorders Clinical Descriptions and Diagnostic Guidelines

For the Somatoform Disorders diagnostic criteria for research see Page 127 of this free ICD-10 PDF:
ICD-10 for Mental and Behavioural Disorders Diagnostic Criteria for Research

For DSM-5 Somatoform Disorders diagnostic criteria and descriptions see BehaveNet site

A note for those not familiar with current DSM-5 proposals: The DSM-5 Somatic Symptom Disorders Work Group (originally called the Somatic Distress Disorders Work Group) is proposing a radical reorganization of the DSM-IV Somatoform Disorders section.

As the DSM-5 Development site documentation currently stands, the Work Group proposes to rename Somatoform Disorders to Somatic Symptom Disorders and to run a number of existing somatoform disorders together into a new category, which it proposes to call Somatic Symptom Disorder.

Somatic Symptom Disorder (SSD) would include the previous DSM-IV diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307].

There is also an Illness Anxiety Disorder (hypochondriasis without somatic symptoms); and a proposal to rename Conversion Disorder to Functional Neurological Disorder and possibly locate under Dissociative Disorders.

View all category and criteria proposals on the DSM-5 Development site:

Somatic Symptom Disorders

J 00 Somatic Symptom Disorder – with the option for specifying:

Mild Somatic Symptom Disorder
Moderate Somatic Symptom Disorder
Severe Somatic Symptom Disorder

J 01 Illness Anxiety Disorder |
J 02 Conversion Disorder (Functional Neurological Symptom Disorder) |
J 03 Psychological Factors Affecting Medical Condition |
J 04 Factitious Disorder |
J 05 Somatic Symptom Disorder Not Elsewhere Classified |


“Bodily Distress Disorders” to replace “Somatoform Disorders” category for ICD-11?

Up until Febrary 2012, the ICD-11 Alpha draft linearization for Chapter 5: Somatoform Disorders section was little changed from that in ICD-10, with the exception of what appears to be a new category: “9W6.2 Chronic pain disorder with somatic and psychological factors”, which doesn’t appear in ICD-10 Version: 2010, as a child to F45.4.

When the Alpha Browser was checked on 17 February, the section for Somatoform Disorders had been reorganized.

ICD-11 Beta Draft: Morbidity Linearization view

or see this page on the Beta Browser (click the small grey arrows to display child categories):


So this section currently lists:

ID : http://who.int/icd#F45

05 Mental and behavioural disorders


9R0 Mild bodily distress disorder
9R1 Moderate bodily distress disorder
9R2 Severe bodily distress disorder
9R3 Somatization disorder
9R4 Undifferentiated somatoform disorder
9R5 Somatoform autonomic dysfunction
9R6 Persistent somatoform pain disorder 
       9R6.1 Persistent somatoform pain disorder 
       9R6.2 Chronic pain disorder with somatic and psychological factors [not in ICD-10]
9R7 Other somatoform disorders
9R8 Somatoform disorder, unspecified

The ICD-10 F45 Somatoform Disorders parent class has been renamed to BODILY DISTRESS DISORDERS and displays three new categories:

9R0 Mild bodily distress disorder
9R1 Moderate bodily distress disorder
9R2 Severe bodily distress disorder

Hypochondriacal disorder [ICD-10: F45.2] is now listed as Illness Anxiety Disorder under


ID : http://who.int/icd#F45.2


      ›  9L5.6 Illness Anxiety Disorder

Since no iCAT “Category and Discussion Notes” or “Change history” records display in the public version of the Beta drafting browser, it isn’t possible to determine whether ICD-11 is proposing to introduce three new categories:

9R0 Mild bodily distress disorder
9R1 Moderate bodily distress disorder
9R2 Severe bodily distress disorder

in addition to retaining existing categories 9R3 thru 9R8.

Or, whether the categories currently listed at 9R3 thru 9R8 are destined to be subsumed under three new Bodily distress disorder categories, (in similar fashion to the DSM-5 Work Group’s proposal to combine a number of existing DSM-IV categories into Complex Somatic Symptom Disorder) but the existing codes retained so as not to lose legacy coding data from ICD-10.

None of the three proposed categories have any textual content displaying for them as yet in the disorder descriptions on the right hand side of the Beta Browser pages.

There is insufficient information to determine, at this stage, what disorder(s) ICD-11 proposes these three new terms would capture; how they would be defined or what their relationship would be to the ICD-10 categories that remain listed in this section.

The text that displays in the disorder description frame for new parent code 05 BODILY DISTRESS DISORDERS (formerly Somatoform Disorders) remains unmodified from the imported ICD-10 legacy text:


The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient.

Nor is it evident whether and to what extent these three categories might mirror the proposals for DSM-5, as they stood in May 2011, or following the revisions to proposed categories and criteria the DSM-5 Work Group made for the third and final stakeholder review exercise, in May 2012.


Congruency with DSM-5 constructs?

Other sources (which I shall be writing about in Part Two) suggest these new categories may be proposed to replace the “medically unexplained symptoms” element of the Somatoform Disorders categories in ICD-10 and that they might be applicable to “medically unexplained” and “medically explained” somatic symptoms, if the latter were considered to be “abnormally prolonged and accentuated.”

Compare this with the conceptual framework the DSM-5 Somatic Symptom Disorder Work Group proposes for “de-emphasizing ‘medically unexplained symptoms’ as a diagnostic criterion” which will

“…allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome.”  [1]

And with the most recent version of the Somatic Symptom Disorders  “Disorder description” proposals document (as it stood in May 2011 for the second DSM-5 stakeholder review)

“…These disorders typically present first in non-psychiatric settings and somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.”  [2]

The DSM-5 Work Group’s proposals would allow for dual diagnosis of Somatic Symptom Disorder + diagnosed illness or a Somatic Symptom Disorder + a so-called “functional somatic syndrome” if the patient were considered to meet the criteria.


[1] [PDF] Editorial: Dimsdale J, Creed F. The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report. Published on behalf of the Somatic Symptom Disorders Work Group. J Psychosom Res, 66 (2009) 473–476.  PMID: 19446706 [PubMed – indexed for MEDLINE]

[2] [PDF] Somatic Symptom Disorders Work Group Disorder Descriptions, Second DSM-5 stakeholder review and comment exercise, May 04, 2011.

To be continued in Part Two


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