23. Somatoform Disorders

Question 1

what are the 3 distinct clinical disorders that are very similar to each other in this area?

Answer 1

• malingering
• factitious disorder
• somatoform disorders

Question 2

define malingering

Answer 2

not a mental disorder. represents a conscious faking of sx in order to obtain a conscious goal.

Question 3

define factious disorder

Answer 3

conscious attempt to simulate illness, by falsifications of sx or direct intervention to produce physical signs (injecting air into tissues to simulate gas forming infection)

Question 4

somatoform disorders: conscious? lying? self-harm?

Answer 4

NOT conscious, does not involve lying or deliberate self-harm

Question 5

with somatic complaints, what else might be going on?

Answer 5

depression and anxiety can present with somatic complaints as the most prominent symptoms. also, anxiety, substance abuse, psychotic disorders, dementia, personality disorders

Question 6

somatoform disorders: general overview?

Answer 6

symptoms suggest general medical disorders, but no underlying disease can be demonstrated, no evidence that the patient is faking it or inducing clinical data. plea for human contact and support rather than a form of manipulation.

Question 7

what are primary goals of treatment of somatoform disorders?

Answer 7

avoiding unnecessary diagnostic procedures, relief of suffering

Question 8

what parts of the history may tip us off about somatoform disorders?

Answer 8

a long history of being a patient, intense interest in details of sx, vague ailments, doctor shopping.

Question 9

psychological probing of someone with a somatoform disorder may reveal what?

Answer 9

masochism, guilt, dependency, hostility, anger.

Question 10

what are the various types of somatoform disorders?

Answer 10

-hypochondriasis
-somatization disorder
-unndifferentiated somatoform disorder
-conversion disorder
-pain disorder
-body dysmorphic disorder
similar:
-panic attacks
-delusional d/o, somatic type
-psych factors affecting med condition
-adjustment disorder
-MDD with psychotic sx
-DSM5: illness anxiety, with care avoidance or care excess

Question 11

hypochondriasis: patient cognitions?

Answer 11

preoccupation with belief that they have a terrible disease, which dominates their interactions with clinicians. normal sensations are magnified.
usually presents with a detailed, obsessive history of sx.
NOT a delusional disorder (may be able to reality test, change focus)

Question 12

hypochondriasis: treatment?

Answer 12

ongoing relationship with an empathetic caregiver. scheduled appointments without requirement of a symptom to present.
CBT good adjunct

Question 13

somatization disorder: age of onset?

Answer 13

adolescence or early adulthood (prior to age 30)

Question 14

somatization disorder: definition?

Answer 14

drama, onset prior to 30y, multiple vague symptoms commonly affecting GI, CV, reproductive and neuro systems (must affect all of these systems at different times)

Question 15

somatization disorder: past history that is common?

Answer 15

psychiatric disorders, substance abuse, sociopathy

Question 16

somatization disorder: treatment

Answer 16

management rather than cure. frequent scheduled visits, emotional support, minimized tests/meds. psychotherapy may or may not be useful; pt has to be willing and have insight
CBT may be good

Question 17

undifferentiated somatoform disorder (NOS)

Answer 17

one or more complaints that cannot be accounted for by a known medical condition, persist for more than 6 months. usually vague sx, like fatigue, weakness, loss of appetite.

Question 18

conversion disorder: def

Answer 18

alteration in physical functioning involving the sensory or voluntary motor system. expression of psych conflict rather than a disease.
excludes PAIN or sexual dysfunct.
preceded by stress/conflict

Question 19

conversion disorder: required for dx?

Answer 19

linkage to psychological stressors or conflict is required for diagnosis.

Question 20

conversion disorder: what does it represent?

Answer 20

classically represents attempt by the sufferer to communicate a conflict via somatic means something which cannot be expressed verbally.

Question 21

what is primary gain?

Answer 21

function of the system to keep a psych conflict or need out of conscious awareness.

Question 22

what is secondary gain?

Answer 22

funtion of the system to relieve the patient of some obligation or activity, or to receive care which otherwise might not be offered.

Question 23

when are conversion disorders common?

Answer 23

in the course of chronic illness, esp in individuals with conflict about dependency.

Question 24

pain disorder: definition?

Answer 24

a conversion disorder in which pain is the only symptom. psychological factors are presumed to play a role in the onset, severity, exacerbation of the pain
-may also be a medical condition, but pain is exacerbated by psych factors

Question 25

pain disorder: treatment?

Answer 25

most effective treatment is prevention. many cases of somatoform disorder start with acute painful conditions (ie disc disease). effective pain management can help reduce pain behaviors.

Question 26

body dysmorphic disorder: definition

Answer 26

continuing preoccupation with a defect in appearance. becomes dominant in daily life, affects functioning.

Question 27

Factitious Disorders v. Malingering: general difference?

Answer 27

both imply voluntary production of symptoms. FD: motivation is an unconscious need to be a patient. Malingering: motivation is need to achieve a clear secondary gain (narcotics, compensation for PTSD).

Question 28

Factitious Disorders v. Malingering: which is more voluntary?

Answer 28

FD is thought to be more voluntary. Best viewed as a form of compulsive behavior. Ex: pt swallowed open safety pins.

Question 29

Factitious Disorder by Proxy: definition?

Answer 29

FD by proxy = rare, the patient describes or produces sx in a child who is brought in for treatment.

Question 30

Factitious Disorders: treatment

Answer 30

difficult, unlikely to be cured. can be terminal. psych referral. may use CBT, group therapy.

Question 31

is malingering a psych dx?

Answer 31

NO, it is not a psychiatric disorder, it is lying/manipulating; intentional production for secondary gain.

Question 32

commonalities among somatoform disorders?

Answer 32

• physical sx or concern about physical sx
• not fully explained by medical illness or other psych d/o
• symptoms NOT intentionally produced or feigned
• symptoms cause distress/impairment

Question 33

what is La belle indifference? in what disorder does it present?

Answer 33

indifference to symptom - pt may not be anxious about being blind, for ex
presents in conversion disorder

Question 34

in what disorder can pts have pseudoseizures?

Answer 34

conversion disorder.

10-60% of pts with pseudoseizures also have epilepsy

Question 35

conversion d/o? recovery rates?

Answer 35

usually 90% even without treatment. blindness/paralysis just get better on their own

Question 36

pain disorder is associated with what other psych disorders?

Answer 36

mood disorder, anxiety disorder

Question 37

pain disorder: tx?

Answer 37

maintain activity (PT/OT)
CBT
complementary med

Question 38

hypochondriasis: treatment

Answer 38

regular visits, reassurance.

CBT

Question 39

body dysmorphic disorder: what else could it be, particularly if there is low insight?

Answer 39

delusional disorder, somatic type

Question 40

classic case: female nurse with hypoglycemia. insulin has been self-administered.

Answer 40

Factitious disorder, physical type

Question 41

how has the classification of Factitious disorder changed from DSM4 to DSM5?

Answer 41

in DSM5 it is in the somatoform chapter. DSM4: not considered a somatoform disease.

Question 42

what is the primary driver in factitious disorder?

Answer 42

to be a patient/under medical care. sx may be psychological or physical or both.

Question 43

Munchausen: def

Answer 43

creating or exaggerating sx