Which is the primary gain for a client with conversion disorder?

The latest edition of DSM 5 has moved away from the need to have no medical explanation in order to make the diagnosis of ‘medically unexplained symptoms’ and gain access to appropriate treatment.  The emphasis now is on symptoms that are substantially more severe than expected in association with distress and impairment.  The diagnosis includes conditions with no medical explanation and conditions where there is some underlying pathology but an exaggerated response. 

‘The major diagnosis in this diagnostic class, Somatic Symptom Disorder, emphasises diagnosis made on the basis of positive symptoms and signs [distressing somatic symptoms plus abnormal thoughts, feelings, and behaviours in response to these symptoms] rather than the absence of a medical explanation for somatic symptoms.  A distinctive characteristic of many individuals with somatic symptom disorders is not the somatic symptoms per se, but instead the way they present and interpret them.’[APA, 2013]

A new category has therefore been created under the heading ‘Somatic Symptom and Related Disorders’.    This includes diagnoses of Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, Factitious Disorder, and a variety of other related conditions.  The term ‘Hypochondriasis’ is no longer included.  In two of the conditions the absence of any medical pathophysiology is a criteria for diagnosis; these are Conversion Disorder and Other Specified Somatic Symptom and Related Disorder [which includes Pseudocyesis, a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy].

Somatic Symptom Disorder

The diagnostic criteria for Somatic Symptom Disorder noted in DSM 5 are:

1. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
2. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
   1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
   2. Persistently high level of anxiety about health or symptoms.
   3. Excessive time and energy devoted to these symptoms or health concerns.
3. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent [typically more than 6 months].

Specify if:

With predominant pain [previously pain disorder]: This specifier is for individuals whose somatic symptoms predominantly involve pain.

Specify if:

Persistent: a persistent course is characterized by severe symptoms, marked impairment, and long duration [more than 6 months].

Specify if:

Mild: Only one of the symptoms specified in Criterion B is fulfilled.

Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.

Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints [or one very severe somatic symptom].

The expected prevalence of Somatic Symptom Disorder stated in DSM 5 is higher than that for Somatization Disorder [