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Mental Disorders Due to a General Medical Condition

TO THE EDITOR: The term "organic" was dropped from DSM-IV in order to help emphasize that the neurobiological underpinnings of psychiatric disorders are increasingly recognized.¹ Thus, in DSM-IV the major diagnostic categories include a diagnostic entity where the phrase "due to a general medical disorder" is used (e.g., psychotic disorder due to a general medical disorder and mood disorder due to a general medical disorder). Furthermore, there is a category "Mental Disorders Due to a General Medical Condition," which includes the diagnosis of "Mental Disorder Not Otherwise Specified Due to a General Medical Disorder."

A number of well-described but very heterogeneous clinical conditions conceivably fall under this last rubric. For example, a literature search reveals several cases where eating disorders due to a general medical disorder have been misdiagnosed as anorexia nervosa.² Similarly, there are reported cases of paraphilia due to a general medical disorder,³ of impulse control disorders due to a general medical disorder,⁴ and of course (as the DSM-IV notes) of dissociative symptoms due to a general medical disorder.

We would argue that at least some of these additional conditions are sufficiently important to deserve their own specific diagnostic term. In particular, the misdiagnosis of a general medical disorder with eating symptoms as anorexia nervosa may have grave consequences. We would argue that the availability of a diagnostic entity such as "Eating Disorder Due to a General Medical Condition" would help clinicians to appreciate an important differential diagnosis in patients with eating disorder symptoms.² Similar considerations would apply in the sections on paraphilia, impulse control disorder, and so on.

REFERENCES

1. Spitzer RL, First MB, Williams JBW, et al: Now is the time to retire the term "organic mental disorders." Am J Psychiatry 1992; 149:240–244[Abstract/Free Full Text]
2. Jordaan G, Stein DJ: Eating disorders due to a general medical condition: a proposal for a new diagnostic entity. S Afr Med J 1998; 88:1486–1493
3. Stein DJ, Hugo F, Oosthuizen P, et al: Neuropsychiatry of hypersexuality: three cases and a discussion. CNS Spectrums, in press
4. Stein DJ, Wessels C, Carr J, et al: Hair-pulling in a patient with Sydenham's chorea (letter). Am J Psychiatry 1997; 154:1320

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