basing the diagnosis on negative rather than positive manifestations. Patients regard the terminology as offensive. It is difficult to understand the prevalence and treatment of such disorders as long as a hierarchical decision model prevents diagnosing these disorders when other psychiatric disorders are present. The workgroup feels that the hallmark of such disorders is the presence of somatic symptoms associated with significant distress and/or dysfunction. These disorders typically present first in nonpsychiatric settings. Somatic symptoms are common in every day life & may be initiated, exacerbated or maintained by combinations of biological, psychological and social factors. Somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. When criteria are fulfilled, for example, for major affective disorder and for complex somatic symptom disorder, both diagnoses should be coded.