PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 1a. Before age 30, (or currently, if subject is < 30 year old) did/do you have a lot of physical health problems or medical problems? | som_1a | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| Probe: Was treatment sought, how often? How impairing? | som_1a_resp | Y | notes | - | - | - | |
| 1b. Have you missed work or school more than twice because of headaches? | som_1b | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| DIAGNOSTIC CRITERIA FOR SOMATIZATION DISORDER: | som_diag | N | checkbox | 1, A. A history of many physical complains beginning before age 30 years that occure over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. | 2, B.(1) Four pain symptoms: a history of pain related to at est four different sites or functions (e.g., head, abdomen, back, joint, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) | 3, B.(2) Two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods) | 4, B.(3) One sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy) | 5, B.(4) One pseudoneurologic symptom: a history of at least one symptom or deficit suggesting a neurological disorder not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, blindness, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia, or loss of consciousness other than fainting) | 6, C.(1) After appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication) | 7, C.(2) When there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings. | 8, D. The symptoms are not intentionally produced or feigned (as in Factitious Disorder or Malingering) | - | - | |
| 2a. Temporary blindness in one or both eyes lasting several seconds or more? | som_2a | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2b. double vision? | som_2b | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2c. completely losing your hearing for a few seconds or longer? | som_2c | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2d. being paralyzed, where you could not move a part of your body for at least a few minutes? | som_2d | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2e. periods of weakness where you could not lift or move things you could normally lift or move? | som_2e | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2f. trouble walking?(balance or coordination problems) | som_2f | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2g. being unable to urinate or having difficulty urinating for 24 hours or longer or having to be catheterized(other than after childbirth or surgery)? | som_2g | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2h. having a lump in your throat that made it difficult to swallow (other than when you feel like crying)? | som_2h | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2i. having a seizure or convulsion(where you had staring spells or were unconscious and your body jerked)? | som_2i | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2j. being unconscious or fainting (not seizures)? | som_2j | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2k. amnesia for a period of several hours or days where you could not remember afterwards anything that happened? | som_2k | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| 2l. other similar symptoms, such as loss of speech,or numbness in a part of the body? | som_2l | N | radio | 0, None | 1, Yes - mild (never saw physician/never took medication/did not interfere with usual activities) | 2, Yes - always secondary to alcohol or drug use | 3, Yes - always part of medically explained physical disorder | 4, Yes - medically unexplained | - | - | |
| Specify | som_m | Y | text | - | - | - | |
| Notes: | somatizationcsv_notes | Y | notes | - | - | - |