4. Dissociative trance: This condition is characterized by an acute narrowing or com— plete loss of awareness of immediate surroundings that manifests as profound unre- sponsiveness or insensitivity to environmental stimuli. The unresponsiveness may be accompanied by minor stereotyped behaviors (e.g., finger movements) of which the in- dividual is unaware and/or that he or she cannot control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly ac- cepted collective cultural or religious practice.
300.15 (F44.9)
This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any 01 the disorders in the dissociative disorders diagnostic class. The unspecified dissociative disorder category is used in situations in which the clinician chooses not to specify the rea- son that the criteria are not met for a specific dissociative disorder, and includes presen- tations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).
Somatic, T‘_
Somatic sym ptom d isorder and other disorders with prominent somatic symp- toms constitute a new category in DSM-S called somatic symptom and related disorders. This chapter includes the diagnoses of somatic symptom disorder, illness anxiety disorder, con- version disorder (functional neurological symptom disorder), psychological factors affect- ing other medical conditions, factitious disorder, other specified somatic symptom and related disorder, and unspecified somatic symptom and related disorder. All of the disor- ders in this chapter share a common feature: the prominence of somatic symptoms associ— ated with significant distress and impairment. Individuals with disorders with prominent somatic symptoms are commonly encountered in primary care and other medical settings but are less commonly encountered in psychiatric and other mental health settings. These reconceptualized diagnoses, based on a reorganization of DSM-IV somatoform disorder di- agnoses, are more useful for primary care and other medical (nonpsychiatric) clinicians.
The major diagnosis in this diagnostic class, somatic symptom disorder, emphasizes diagnosis made on the basis of positive symptoms and signs (distressing somatic symp- toms plus abnormal thoughts, feelings, and behaviors in response to these symptoms) rather than the absence of a medical explanation for somatic symptoms. A distinctive char- acteristic of many individuals with somatic symptom disorder is not the somatic symp- toms per se, but instead the way they present and interpret them. Incorporating affective, cognitive, and behavioral components into the criteria for somatic symptom disorder pro—
Vides a more comprehensive and accurate reﬂection of the true clinical picture than can be achieved by assessing the somatic complaints alone.
The principles behind the changes in the somatic symptom and related diagnoses from
DSM-IV are crucial in understanding the DSM-S diagnoses. The DSM-IV term somatoform disorders was confusing and is replaced by somatic symptom and related disorders. In DSM-IV there was a great deal of overlap across the somatoform disorders and a lack of clarity about the boundaries of diagnoses. Although individuals with these disorders primarily present in medical rather than mental health settings, nonpsychiatric physicians found the
DSM-IV somatoform diagnoses difficult to understand and use. The current DSM-S clas- sification recognizes this overlap by reducing the total number of disorders as well as their subcategories.
The previous criteria overemphasized the centrality of medically unexplained symptoms.