Class 9

Question 1

Name the somatic symptoms and related disorders

Answer 1

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder - Functional Neurological Symptoms Disorder
Psychological Factors Affecting other Medical Conditions
Factitious Disorder
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder

Question 2

Somatic Symptom Disorder criteria

Answer 2

One or more somatic symptoms that are distressing or
result in significant disruption of daily life
Excessive thoughts, feelings, and behaviors…at least one ofthe following:
-Disproportionate and persistent thoughts about the
seriousness of one’s symptoms
-Persistently high level of anxiety about health or symptoms
-Excessive time and energy devoted to these symptoms
The state of being symptomatic is persistent typically
more than 6 months
Specify: predominate pain, persistent, mild (1B) moderate(2Bs), Severe (2Bs + multiple sx)

Question 3

Epidemiology Somatic Symptom Disorder

Answer 3

5-6%
Female:male = 2 3:1
Increased somatization with age
Low socioeconomics, low education, rural 
onset 20s-30s

Question 4

Illness Anxiety Disorder criteria

Answer 4

Preoccupation with having or acquiring a serious illness
Somatic symptoms are not present or only mild in
intensity
High level of anxiety about health, easily alarmed about
personal health status
Excessive health related behaviors or exhibits
maladaptive avoidance
Illness preoccupation minimum 6 months
Not better accounted for by another mental disorder
Specify: Care seeking type, Care avoidant type

Question 5

Epidemiology Illness Anxiety Disorder

Answer 5

Gender Differences- None

Increased with age

Question 6

Body Dysmorphic Disorder criteria

Answer 6

Preoccupation with one or more perceived defects or
flaws
Repetitive behaviors or mental acts in response
Significant distress or impairment
Appearance preoccupation in not better explained by
eating disorder
Specify: muscle dysmorphia, good or fair insight,
poor insight, absent insight/delusional beliefs

Question 7

Epidemiology Body Dysmorphic Disorder

Answer 7

Female>=Male

Question 8

Conversion Disorder criteria

Answer 8

One or more symptoms of altered voluntary motor or
sensory function
Clinical findings incompatible with neurological or
medical conditions
Not better explained by another disorder
Clinically significant distress or impairment
Specify: weakness or paralysis, abnormal movement,
swallowing symptoms, speech symptom, attacks or
seizures, anesthesia or sensory loss, special sensory
symptom (visual, olfactory, hearing), mixed symptoms

Question 9

Clues to know it’s conversion disorder

Answer 9

Past history
Secondary gain 
Belle indifférence: unconcerned about the problem
Pain/ temperature split 
Vibration/ sensory split 
Changing pattern 
Give away weakness

Question 10

Conversion disorder: good prognosis

Answer 10

Acute onset, comorbid psychiatric disorder,

change in marital status

Question 11

Conversion disorder: course

Answer 11

30 60% chronic

Question 12

Psychological Factors Affecting Other Medical

Conditions criteria

Answer 12

A medical symptom or condition is present
Psychological or behavioral factors adversely affect the
medical condition:
-Influence the course
-Interfere with treatment
-Present a well established health risk
-Influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention
Not better accounted for by another disorder
Specify: mild (increases medical risk), Moderate
(aggravates medical condition), Severe (results in
admission or ER visit), Extreme (life threatening ie:
avoiding treatment)

Question 13

Factitious Disorder imposed on self criteria

Answer 13

Falsification of physical or psychological signs or
symptoms, induction of injury, disease, associated with
identified deception
Presents himself to others as ill, impaired, injured
Absence of obvious external rewards
Not better explained by another disorder
Specify: single or recurrent episodes

Question 14

Factitious Disorder imposed on others criteria

Answer 14

Same
Presents another individual (victim) to others as ill,
impaired, injured
Same
Same
Specify single or recurrent episodes

Question 15

Munchhousen’s syndrome

Answer 15

Triad of:
Simulated illness
Pathological lying “pseudologica fantastica”
Wandering “peregrination”

Question 16

Factitious Disorder epidemiology

Answer 16

Personality disorder
Antisocial (male)
Health Care workers (female)

Question 17

Malingering

Answer 17

external incentive

Question 18

Treatment of Somatoform Disorders

Answer 18

Rule out underlying medical illnesses
Consultation
Identify and treat physical components
Investigate new symptoms
Validate illness experience
Provide a structure for help seeking
 Develop an illness model
 Treat comorbid psychiatric disorders
 Treat symptomatically
 Focus on optimizing functioning not eliminating symptoms
 Begin with life habits
 Elaborate psychological factors

Question 19

Principles of treatment of Somatoform Disorders

Answer 19

The absence of a medical cause of physical
symptoms does not establish the presence of a
somatoform disorder
Review all medical work up
Consider the effects that a label of somatoform
disorder may have on future health care of the
patient

Question 20

Treatment BDD illness anxiety disorder

Answer 20

resemble any other anxiety disorder

Question 21

Treatment somatic symptom disorder

Answer 21

Requires structuring of chaotic symptoms and health
behaviour
Symptomatic treatment such as for pain
Consult letter for GP

Question 22

Treatment conversion disorder

Answer 22

Physical rehabilitation approach

Hypnosis

Question 23

Pharmacotherapy

Answer 23

Antidepressants (anxiety, depression, pain)
Antipsychotics for delusional level of illness
Benzodiazepines (sparingly)

Question 24

Psychotherapy

Answer 24

CBT (+internet): THE BEST
Dynamic therapy (Abbass et al
Self guided therapies
MBSR

Question 25

Comorbid SSD

Answer 25

anxiety, depression (the more physical sx you have, the more likely it’s depression), sud, histrionic personality disorder, BPD, OCPD, antisocial, PTSD

Question 26

Etiology SSD

Answer 26

Genetic
Decrease in serotonin and endorphins
Psychodynamic: aggressive wishes towards others are transferred into physical complaints. Deserved punishment, defense against guilt, expression of low self-esteem
Family dynamics: some families have difficulty expressing emotions and resolving conflicts – child becomes ill to shift focus from conflict
Social learning: modeling
Transactional model of stress/ adaptation

Question 27

SSD course

Answer 27

Fluctuating course. 1/3 improve significantly. Stressors. Easy on, easy off. Good prognosis: high socioeconomic status, treatment responsive anxiety/ depression, sudden onset, no personality, no GMC

Question 28

Epidemiology conversion

Answer 28

+ W, left side of body 10-35 years, rural, low socioeconomic, low IQ, low education, military with combat.
*M: link with antisocial perso, involved in occupational/ military accident

Question 29

Types od sx conversion

Answer 29

Paralysis, seizures, blindness

Coordination disturbance, urinary retention, deafness, anosmia, loss of pain sensations, pseudoyesis (false pregnancy)

Question 30

Conversion vs SSD

Answer 30

conversion neurological in nature only

Question 31

Primary gain

Answer 31

Excused from troublesome duties

Question 32

Secondary gain

Answer 32

money

Question 33

tertiary gain

Answer 33

gain for someone in the family

Question 34

Malingering

Answer 34

for a secondary gain, an external reward