The diagnosis of somatoform disorders requires a careful chart review. It is important to remember that the primary team may not have completely ruled out medical causes because of curious interactions with the patient or the nature of the patient's complaints. Also, because of the significant comorbidity of other Axis I disorders, it is important to assess for anxiety, mood, and psychotic disorders as well and treat them as necessary.
Somatization disorder
It is extremely important to review past medical records to diagnosis somatization disorder. One would see a history of medically unexplained symptoms, beginning in the teens and many recurrent symptoms. A long list of medication allergies is not uncommon along with unusual reactions.
Conversion disorder
After ruling out physical causes for the symptom, it is important to identify an actual stressor that precipitates the conversion disorder. Even with these criteria being met, one can be wrong.
Hypochondriasis
Hypochondriasis in a medical setting is often secondary to anxiety or somatization disorder.
Body dysmorphic disorder
Body dysmorphic disorder is usually readily identified, but can also occur in the context of affective disorders. If the perception of the defect reaches delusional proportions, then a delusional disorder should be considered.
Pain disorder
Because pain is also part of somatization disorder, it is important to consider it in the differential and check for other somatization symptoms. Mood and anxiety disorders can manifest as complaints of pain, so they need to be ruled out.
Factitious disorder
Factitious disorder is challenging to diagnose and the previous medical history, to the extent it can be reviewed, is very helpful.
Malingering
The most compelling aspect in the diagnosis of malingering is the identification of secondary gain and symptoms that do not properly fit the context of medical or psychiatric illness.