97B Somatoform Disorders

Question 1

Somatoform disorders

Answer 1

Category of disorders characterized by physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Symptoms not intentionally produced or feigned. More common in women.

Question 2

Somatization disorder criteria

Answer 2

Variety of unexplained complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years, developing before age 30 years leading to lots of medical procedures

Question 3

Somatization course

Answer 3

chronic, fluctuating with high disability and costs; eventually goes away with increasing age

Question 4

typical somatization patient

Answer 4

all chicks under 30 with low education and low SES with a long medical hx (including suicide attempts and psych comorbidities) and lots of allergies

Question 5

how to treat somatization

Answer 5

nonconfrontational approach
PCP should treat 
Don't do invasive testing (do no harm
peer consultation (w/ another MD)
cognitive behavior therapy

Question 6

Hypochondriasis

Answer 6

Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

Question 7

Body dysmorphic disorder

Answer 7

Preoccupation with minor or imagined defect in appearance, leading to significant emotional
distress or impaired functioning; patients often repeatedly seek cosmetic surgery

Question 8

Conversion

Answer 8

-Sudden loss of sensory or motor function (e.g., paralysis, blindness, mutism), often following
an acute stressor; patient is aware of but sometimes indifferent toward symptoms (“la belle
indifférence”); more common in females, adolescents, and young adults.
-If male then look for real medical issue
-psychiatric comorbidity common (somatoform)

Question 9

management of conversion

Answer 9

use behavioral programs and scipts

Question 10

Malingering

Answer 10

Patient consciously fakes or claims to have a disorder in order to attain a specific 2° gain (e.g.,
avoiding work, obtaining drugs). Poor compliance with treatment or follow-up of diagnostic tests.
Complaints cease after gain (vs. factitious disorder).

Question 11

Factitious disorder

Answer 11

Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (1° gain).
Willing to undergo painful tests

Question 12

Munchausen’s syndrome

Answer 12

Chronic factitious disorder with predominantly physical signs and symptoms. Characterized by a
history of multiple hospital admissions and willingness to receive invasive procedures.
Often in medical field

Question 13

Munchausen’s syndrome by proxy

Answer 13

When illness in a child or elderly patient is caused by the caregiver. Motivation is to assume a sick
role by proxy. Form of child/elder abuse.