Classification

The diagnostic criteria for somatization disorder and related disorders have varied, with different permutations of the diagnostic terminology reflecting difficulties in classification and in establishing valid criteria. The distinction between the individual somatoform disorders is unclear, which means that the majority of patients will exhibit clinical characteristics from different diagnostic categories. (5) Because somatization disorder is so chronic and enduring and is linked with personality disorders, it has been suggested that it is classified as an Axis II personality disorder instead of an Axis I disorder in the DSM. (1J

Except for hypochondriasis, the somatoform disorders' categories are primarily based on the number or specificity of bodily symptoms and on the duration of illness. They may be divided into acute and chronic forms, into a multisymptomatic form, and into a form in which the patients only present few symptoms or symptoms mainly referring to a single organ system. The somatization disorder diagnosis includes the most chronic multisymptomatic cases lasting for 2 years or more.

The ICD-10 criteria require the following:

1. at least 2 years of multiple and variable physical symptoms for which no adequate physical explanation has been found;

2. persistent refusal to accept the advice or reassurance of several doctors that there is no physical explanation for the symptoms;

3. some degree of impairment of social and family functioning attributable to the nature of the symptoms and resulting behaviour.

The ICD-10 criteria require 'multiple physical symptoms' to include at least six out of 14 predefined symptoms, involving at least two of the following: gastrointestinal, cardiovascular, urogenital, or skin or pain symptoms. In contrast, the DSM-IV criteria ( Table 1) demand four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom that are not fully explained by a medical condition. No specific symptoms are listed but examples are given. Consequently, there is only poor to moderate agreement between the DSM-IV and ICD-10 diagnostic criteria. (19>

Cases lasting less than 2 years are classified as undifferentiated somatization disorder. In ICD-10 multiple symptoms are required, which is not the case in DSM-IV. Diagnosis

A somatization disorder should be suspected in any individual with a vague or complicated medical history or unaccountable non-responsiveness to therapy. Patients with somatization disorder often deny emotional symptoms or conflicts, so the absence of significant emotional symptoms at the general psychiatric interview and history taking will not exclude the diagnosis. But the presence of a previous or current emotional disturbance does support the diagnosis, as do previous episodes of medically unexplained bodily symptoms. Taken at face value, the physical symptoms are only of modest diagnostic importance, whereas unspecific or atypical symptoms, or a very unusual presentation, speak in favour of the diagnosis. Multiple fluctuating symptoms of obscure origin, and onset before the age of 30, strongly support the diagnosis.

The DSM-IV diagnostic criteria for somatization disorder are displayed in TlbieJ./™ The key feature is of multiple medically unexplained symptoms in several bodily systems beginning at least 2 years previously, with an onset before the age of 30.

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Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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