conversion disorders. In addition, the term pain disorder is reserved for syndromes specifically characterized by the occurrence of persistent unexplained pain. In all cases, symptoms are classified as unexplained if adequate medical investigation has failed to identify a plausible physical cause for their occurrence; they must also cause clinically significant functional disability or distress to meet diagnostic criteria. Moreover, the symptoms should not be attributable to hypochondriasis or other forms of overt psychopa-thology, such as anxiety, depression, or psychosis. In addition, DSM-IV assumes that somatoform symptoms are not produced intentionally by the person. Rather, "unexplained" symptoms that are intentionally produced in order to obtain medical attention (e.g., as in Munchausen's disorder) are classified within the factitious illness category; symptoms that are intentionally produced for personal gain (e.g., in the context of a litigation claim or to avoid military service) are labeled as instances of malingering.

The DSM-IV dissociative disorders category includes unexplained symptoms involving an apparent disruption of consciousness, such as instances of amnesia and the alteration of personal identity (encompassing dissociative amnesia, dissociative fugue, and dissociative identity disorder). Depersonalization disorder, characterized by persistent and unpleasant feelings of detachment from the self or the world, is also placed within this category. Although, strictly speaking, the dissociative disorders should be viewed as one dimension of the hysteria concept, they are not typically regarded as medically unexplained symptoms and we will not consider them in detail in this article.

The nosological status of medically unexplained symptoms continues to provoke controversy. First, there is very little evidence to suggest that there are natural boundaries between the different categories of somatoform illness. Indeed, evidence suggests that the different somatoform categories should be regarded as points on a continuum of severity, with somatization disorder at the pathological extreme. Second, the persistence and stability of many cases of somatoform illness suggest that these conditions could be more appropriately viewed as a form of personality disorder rather than an acute psychiatric condition in their own right.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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