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Physical Symptoms - Eating, Sleep, and other

Updated: Jul 31, 2020

Physical symptoms can often be a sign of mental illness. The key to determining between the two is to find out which symptoms coexist, how long they've been around, and generally to just determine if a person's experience is consistent with the criteria of a diagnosable disorder.

Some symptoms that are physical in nature, but are also common in mental illness can include sleep issues, appetite changes, avoidance/fear of food, hyperfocus on weight/appearance, sexual dysfunction, sudden and unexplained loss of physical functioning in some part of the body, and many others. It's always important to rule out physical/medical issues with a licensed physician before considering mental illness as a cause for physical symptoms.

Sleep Disorders

Insomnia Disorder G47.00

  • Duration – at least 3 months at least 3 nights/wk

  • Symptoms: 1 or more:

    • Difficulty sleeping

    • Difficulty staying asleep

    • Early morning waking/inability to stay asleep

    • Significant distress and impairment

Hypersomnolence Disorder G47.10

  • Duration – at least 3 nights/wk for at least 3 months

  • Symptoms:

    • Excessive sleepiness despite main sleep period lasting at least 7hrs with one of the following:

    • Recurring sleep lapses within same day

    • Prolonged (unrefreshing) sleep for 9 hrs or more per day

    • Difficulty being fully away after abrupt awakening


  • Duration: 3 months

  • Onset: typically in childhood or adolescence/young adulthood

  • Symptoms: Daily irresistible attacks of refreshing sleep as evidenced by one of the following:

    • Cataplexy (sudden loss of muscle tone)

    • Hypocretin deficiency measured via cerebrospinal fluid at 33% or less than those levels found in a healthy individuals

    • Demonstrated REM sleep latency of 15 minutes or less on nocturnal sleep polysomnography, or mean sleep latency of 8 minutes or less and a minimum of two sleep-onset REM periods demonstrated on multiple sleep latency test

  • Diagnostic Codes:

    • W/o cataplexy w hypocretin deficiency G47.419

    • W cataplexy w/o hypocretin deficiency G47.411

    • Autosomal dominant cerebellar ataxia and deafness G47.419

    • Autosomal dominant narcolepsy, obesity, and type2 diabetes G47.419

    • Secondary to another medical condition G47.429

Obstructive Sleep Apnea Hypopnea G47.33

  • Symptoms:

  • Polysomnography of 15 or more obstructive apnea/hypopneas per hr of sleep with no symptoms required OR

  • Polysomnography of at least 5 obstructive apnea/hypopneas per hr of sleep with either of the following:

    • Nocturnal breathing disturbances

    • Daytime sleepiness, fatigue, unrestful sleep

Central Sleep Apnea

  • Symptoms:

    • Evidence by polysomnography of 5+ central apneas/hr of sleep

  • Diagnostic Codes:

    • Idiopathic CSA G47.31

    • Cheyne-Stokes breathing R06.3

    • CSA comorbid w opioid use G47.37

Sleep-Related Hypoventilation

  • Symptoms:

    • Polysomnography episodes of decreased respiration associated with elevated C02

  • Diagnostic Codes:

    • Idiopathic Hypoventilation G47.34

    • Congenital central alveolar hypoventilation G47.35

    • Comorbid SRH G47.36

Circadian Rhythm Sleep-Wake Disorders

  • Symptoms:

    • Persistent or recurrent pattern of sleep disruption due to alteration of circadian system or sleep-wake schedule

    • Excessive sleepiness, insomnia, or both

  • Diagnostic Codes:

    • Delayed sleep phase type G47.21

    • Advanced sleep phase type G47.22

    • Irregular sleep-wake type G47.23

    • Non-24-hour sleep-wake type G47.24

    • Shift work type G47.26

    • Unspecified G47.20

Non-Rapid Eye Movement Sleep Arousal Disorders

  • Symptoms: Recurrent episodes of incomplete awakening from sleep accompanied by either of these:

    • Sleep walking

    • Sleep terrors

    • No or little dream imagery

    • Amnesia for the episode

    • Clinically significant distress or impairment as a result

  • Diagnostic Codes:

    • Sleep walking type F51.3

    • Sleep terror type F51.4

Nightmare Disorder F51.5

  • Symptoms:

    • Repeated occurrence/extended extremely dysphoric and well-remembered dreams usually involving avoidance of threats to survival, security, or physical integrity

    • Rapid disorientation when awoken

    • Clinically significant distress and impairment

Rapid Eye Movement Sleep Behavior Disorder G47.52

  • Symptoms:

    • Repeated episodes of arousal during sleep bc of vocalization and/or complex motor behaviors

    • Happens during REM sleep AKA more than 90 min after sleep onset

    • Upon awakening – awake, alert, not confused or disoriented AND

    • Either of the following:

    • REM sleep without atonia on polysomnographic

    • Hx suggestive of REM sleep behavior disorder and an established synucleinopathy dx (parkinson’s, multiple system atrophy)

    • Clinically significant distress or impairment

Restless Leg Syndrome G25.81

  • Duration – at least 3x per wk for at least 3 months

  • Symptoms: Urge to move legs accompanied by/response to unpleasant sensation characterized by:

    • Urge to move the legs begins or worsens during inactivity

    • Partially or totally relived by movement

    • Worse in the evening or at night

    • Significant impairment or distress

Other Specified Insomnia Disorder G47.09

Unspecified Insomnia Disorder G47.00

Other Specified Sleep-Wake Disorder G47.8

Unspecified Sleep-Wake Disorder G47.9

Eating and Feeding Disorders

Pica F50.8 (F98.3 children)

  • Duration – at least 1 month

  • Symptoms:

    • Eating non-nutritive nonfood substances

Rumination Disorder F98.21

  • Duration – At least 1 month

  • Symptoms:

    • Repeated regurgitation of food not due to other medical/mental issues

Avoidant/Restrictive Food Intake Disorder F50.8

  • Symptoms: No interest in food or concern about how food will impact the body, and failure to achieve sufficient energy or nutritional needs, in addition to at least one of the following:

    • Deficiencies in nutrition

    • Failure to gain weight or significant weight loss

    • Requires nutritional supplements or enteral feeding

    • Psychosocial functioning is impacted. Symptoms are not caused by a lack of available resources, a culturally relevant practice, or medical condition.

  • Differential:

    • Autism Spectrum Disorder – (cause is autism)

    • Specific Phobia – (cause is fear of swallowing/other)

    • Anorexia Nervosa – (cause is desire to lose weight/not gain)

    • Social Anxiety Disorder – (cause is social anxiety)

    • Anxiety Disorders – (caused by anxiety)

    • Obsessive-Compulsive Disorder – (compulsion, obsession, repetition)

    • Major Depressive Disorder – (criteria)

    • Schizophrenia Spectrum Disorders – (psychosis/criteria)

    • Factitious Disorder or Factitious Disorder Imposed on Another (fake or just doing it to do it)

Anorexia Nervosa

  • Duration – Recurrent within the past 3 months – 1 episode up to many years

  • Symptoms:

    • Refusal to maintain body weight that is normal for age and height.

    • Intense fear of weight gain.

    • Disturbance in perception of own body weight/shape and denial of seriousness of low body weight.

  • Specify type:

    • Restricting type (no binge eating or purging)

    • Binge-eating/purging type (involves episodes of binge eating and compensatory behavior)

  • Diagnostic Code:

    • Restricting type F50.01

    • Bing-eating/purging type F50.02

    • Mild: BMI >17

    • Moderate: BMI 16-16.99

    • Severe: BMI 15-15.99

    • Extreme: BMI <15

  • Differential:

    • Bulimia Nervosa – (binge/purge/exercise no serious weight loss)

    • Body Dysmorphic Disorder – (can be comorbid)

    • Avoidant/Restrictive Food Intake Disorder – (avoidance not weight related)

    • Obsessive-Compulsive Disorder – (obsession/compulsion/repetition)

Bulimia F50.2

  • Onset – av adolescent/young adult

  • Duration – at least 3 months

  • Symptoms:

    • Recurrent binge eating with sense of lack of control.

    • Recurrent compensatory behavior (i.e. vomiting, laxatives, diuretics, enemas, fasting, excessive exercise).

    • Disturbance in perception of body shape and weight.

  • Types:

    • Mild: 1-3 episodes per wk

    • Moderate: 4-7 per wk

    • Severe: 8-13 per wk

    • Extreme: 14+ per wk

  • Differential:

    • Anorexia Nervosa, Binge Eating/Purging Type – (weight)

    • Binge-Eating Disorder - (lack of purge)

    • Major Depressive Disorder with Atypical Features – (depression cause)

    • Kleine-Levin Syndrome – (neurological in nature)

    • Borderline Personality Disorder – (impulsive behavior, can be comorbid)

Binge-Eating Disorder F50.8

  • Duration: Binge eating present a minimum of at least once weekly for three months

  • Symptoms:

    • Recurrent episodes of eating excessive amounts of food, beyond what another person would during a similar period

    • feeling unable to stop or curb the amount eaten, eating rapidly, eating to the point of discomfort, eating when not hungry

    • eating in isolation out of shame regarding eating behavior.

    • Feeling guilt, disgust, or depressed with one's self after the binge eating episode.

  • Types:

    • Mild: 1-3 binges per wk

    • Moderate: 4-7 per wk

    • Severe: 8-13 per wk

    • Extreme: 14+ per wk

  • Differential:

    • Bulimia Nervosa – (purging/weight focus)

    • Bipolar Disorders – (manic/depress episodes)

    • Depressive Disorders – (depression caused)

    • Borderline Personality Disorder – (impulsivity/mood)

    • Obesity – (presence of significant binges)

Other Specified Feeding or Eating Disorder F50.8

Unspecified Eating Disorder F50.9

Enuresis F98.0

  • Onset – after age 5

  • Duration – at least 3 months

  • Symptoms:

    • Voiding of urine into bed or clothes involuntarily or intentionally at least twice a week for 3 months causing significant distress

Encopresis F98.1

  • Onset – after age 4

  • Duration – at least 3 months

  • Symptoms:

    • Repeated passage of feces into inappropriate places involuntarily or intentionally at least once per month for 3 months

Other Specified Elimination Disorder R31 or R15.8

Unspecified Elimination Disorder R32 or R15.9

Other Physical Disorders

Somatic Symptom Disorder F45.1

  • Duration: More than 6 months

  • Symptoms:

    • Persistent mental energy engages thoughts and/or worry about one's health, symptoms, and associated concerns. Disproportionately excessive amounts of time and effort are given to address symptoms or health-related issues. At least one somatic symptom is present and is distressing to the point that there is disruption in activities of daily living.

  • Differential:

    • Panic Disorder – (actual recurrent panic attacks)

    • Generalized Anxiety Disorder – (constant worry, no somatic symptoms)

    • Depressive Disorders – (can accompany somatic sx core issue is depression)

    • Illness Anxiety Disorder – (excessive worry about illness mainly)

    • Conversion Disorder – (distress is symptom cause not loss of function)

    • Delusional Disorder – (marked delusions)

    • OCD – (worry about symptoms is not compulsive and repetitive)

Illness Anxiety Disorder F45.21

  • Onset – typical in early/middle adulthood

  • Duration – at least 6 months

  • Symptoms:

    • Fear of having a serious disease(s).

    • Preoccupation with fear exists despite medical evaluation and reassurance.

  • Differential:

    • FOCUS is on anxiety about illness

Conversion Disorder (Functional Neurological Symptom Disorder)

  • Duration:

    • Acute – sx for <6 months

    • Persistent – sx for >6 months

  • Symptoms:

    • Unexplained deficits in voluntary motor or sensory function (blindness, inability to move appendage, etc.). Conflicts or stressors precede the deficits, and the symptoms are not explained medically and are not factitious.

  • Diagnostic Codes:

    • With weakness or paralysis F44.4

    • With abnormal movement F44.4

    • With swallowing sx F44.4

    • With speech sx F44.4

    • With attacks or seizures F44.5

    • With anesthesia or sensory loss F44.6

    • With special sensory sx F44.6

    • With mixed sx F44.7

  • Differential:

    • Somatic Symptom Disorder – (can be comorbid, SSD does not cause actual pain)

    • Factitious Disorder and Malingering – (fake)

    • Dissociative Disorders – (dissociative sx can happen – comorbidity is possible)

    • Body Dysmorphic Disorder – (can be comorbid)

    • Neurological Disease – (caused by neurology)

    • Depressive Disorders – (depression not neurological)

    • Panic Disorder – (can be comorbid)

Factitious Disorder F68.10

  • Onset – usually early adulthood

  • Duration – intermittent episodes

  • Symptoms:

    • Intentional production or feigning of physical or psychological signs or symptoms.

    • One's motivation is to assume the sick role.

    • External incentives are absent (economic gain, avoiding legal responsibility, etc.).

    • Factitious Disorder Imposed on Another

Other Specified Somatic Symptom and Related Disorder F45.8

Unspecified Somatic Symptom and Related Disorder F45.9

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