34 A practical guide to the Istanbul Protocol – for psychologists F44.0 Dissociative amnesia The main feature is loss of memory, usually of important recent events, that is not due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue. The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective. Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue Under dissocative [conversion] disorder see also: F44.1 Dissociative fugue F44.2 Dissociative stupor F44.3 Trance and possession disorders F44.4 Dissociative motor disorders F44.5 Dissociative convulsions F44.6 Dissociative anaesthesia and sensory loss F44.7 Mixed dissociative [conversion] disorders F44.8 Other dissociative [conversion] disorders F45 Somatoform disorders The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient. F45.0 Somatization disorder The main features are multiple, recurrent and frequently changing physical symptoms of at least two years’ duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour. Short-lived (less than two years) and less striking symptom patterns should be classified under undifferentiated somatoform disorder (F45.1). Briquet’s disorder Multiple psychosomatic disorder Excludes: malingering [conscious simulation] ( Z76.5 ) F45.4 Persistent somatoform pain disorder The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder, and which occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical. Pain presumed to be of psychogenic origin occurring during the course of depressive disorders or schizophrenia should not be included here.