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Four clinical cases of recurrent surgery addiction (polyoperes): diagnostic classification in the DSM-IV-TR vs DSM-5

Author(s): Camilla Callegari, Ivano Caselli, Lucia Bianchi, Celeste Isella, Marta Ielmini, Simone Vender

The article presents four clinical cases of patients with the common history of recurrent surgery. These conditions are interesting first of all for general medicine and surgery, apart from psychiatry. Indeed, patients with these characteristics are almost invariably subjected to psychiatric evaluation by internal doctors and surgeons and this is evident in our case reports, despite the rarity of the phenomenon in latest decades aside from plastic surgery. The first aim of the study is to compare diagnostic classifications between DSM-IV-TR and DSM-5 in reference to the case reports of recurrent surgery in order to observe the changes occurring in the diagnostic criteria and classification and the different attitude of the two manuals towards these disorders. The second endpoint is to describe the common features and the differences between the cases that could motivate a different prognostic evolution to raise a hypothesis that could be a starting point for further research. According to previous classification of mental disorders in the DSM IV-TR, patients addicted to recurrent surgery are included in the diagnostic category of “Factitious Disorder with Predominantly Physical Signs and Symptoms”. In the DSM-5 typical clinical manifestations of recurrent surgery are excluded from diagnostic criterions of “Factitious Disorder”. The new manual moves away from the classic nosography tradition and highlights a bigger importance of an objective clinical observation of patients in comparison with the sole clinical history: the most suitable diagnosis is the “Somatic Symptom Disorder”.

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