PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| Since the last interview, have you had a lot of physical problems? Do you worry about your physical health? Does your doctor think you worry too much? | sd_sd_1 | N | yesno | - | - | SOMATIZATION DISORDER | |
| DIAGNOSTIC CRITERIA FOR SOMATIZATION DISORDER Note: If C is applicable, consider either of C.(1) or C.(2) for diagnosis | sd_sd_2 | N | checkbox | 1, A. A history of many physical complains beginning before age 30 years that occur 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 atleast 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) | - | ||
| Since the last interview, have you had one or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary problems)? Have you gone to see doctor about (symptoms)? What was the diagnosis? | sd_usd_1 | N | yesno | - | - | UNDIFFERENTIATED SOMATOFORM DISORDER | |
| DIAGNOSIS CRITERIA FOR UNDIFFERENTIATED SOMATOFORM Note: If B is applicable, it is either one of the two symptoms B.(1) or B.(2) | sd_usd_2 | N | checkbox | 1, A. One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints) | 2, B.(1) After appropriate investigation, the symptoms 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) | 3, B.(2) When there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or a laboratory findings. | 4, C.The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. | 5, D. Duration of the disturbance is at least six months. | 6, E. the disturbance is not better accounted for by another mental disorder (e.g., another Somatoform Disorder, Sexual Dysfunction, Mood Disorder, Anxiety Disorder, Sleep Disorder, or Psychotic Disorder) | 7, F. The symptom is not intentionally produced or feigned (as in Factitious Disorder or Malingering). | - | ||
| Since the last interview, have you been in a lot of physical pain? Does the pain bother you more than most other people with the same condition? | sd_pd_1 | N | yesno | - | - | PAIN DISORDER | |
| DIAGNOSTIC CRITERIA FOR PAIN DISORDER | sd_pd_2 | N | checkbox | 1, A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention. | 2, B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | 3, C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain. | 4, D. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering) | 5, E. The pain is not better accounted for by a Mood, Anxiety, or Psychotic Disorder and dose not meet criteria for Dyspareunia. | - | ||
| Since the last interview, you said that you have been having physical problems with (physical complaints). What do you think is wrong? What had your doctor said was the cause? Were you reassured by what your doctor said? | sd_h_1 | N | yesno | - | - | HYPOCHONDRIASIS | |
| DIAGNOSTIC CRITERIA FOR HYPOCHONDRIASIS | sd_h_2 | N | checkbox | 1, A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. | 2, B. The preoccupation persists despite appropriate medical evaluation and reassurance. | 3, C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder) | 4, D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | 5, E. Duration of the disturbance is at least six months. | 6, F. The preoccupation is not better accounted for by Generalized Anxiety Disorder , Obsessive-Compulsive Disorder, Panic Disorder, a Major Depression Episode, Separation Anxiety, or another Somatoform, Disorder. | - | ||
| Since the last interview, have you been very worried about your appearance in any way? IF YES: What was your concern? Did you think (body part) was especially unattractive? Did this concern preoccupy you? | sd_bdd_1 | N | yesno | - | - | BODY DYSMORPHIC DISORDER | |
| DIAGNOSTIC CRITERIA FOR BODY DYSMORPHIC DISORDER | sd_bdd_2 | N | checkbox | 1, A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive. | 2, B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | 3, C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa) | - |