Medically unexplained symptoms

Question 1

What do we call psychological symptoms that exhibit physical symptoms?

Answer 1

SOMATISATION

Question 2

What is the difference between somatisation and hypochondriacal disorder?

Answer 2

Somatisation disorder (AKA Briquet’s syndrome) is when people have very specific symptoms that they complain of.

Hypochondriacal disorder is when people are convinced of having specific disease. Common examples are cancer or HIV.

Question 3

What are some common symptoms that people with somatisation complain of?

Answer 3

GI and skin most common

Nausea, vomiting, diarrhoea
Itching, burning, tingling
Loss of libido, erectile dysfun, irregular menes, menorrhagia
PAIN
Dysuria, frequency
Paralysis, sensory loss, double vision, seizures

Question 4

Do patients with somatisation usually have numerous symptoms or just one?

Answer 4

Numerous from more than one of these groups

Question 5

What is the risk with patients with somatisation?

Answer 5

That they might ten develop multiple complications from a long series of investigations

For example, people have multiple explorative laparoscopies might end up with multiple adhesions that might end up being an organic source of pain

Question 6

How does the ICD-10 classify somatisation? (3)

Answer 6

• Symptoms must be persisting for at leats 2 years without resolution
• Persistent refusal from the patient to listen to reassurance from multiple doctors is a common theme
• There is often some degree of functional impairment resulting from the symptoms or associated behaviour

Question 7

What is the difference between what patients with somatisation and hypochondriacal disorder will be asking for?

Answer 7

Patients with somatisation are fixated on their symptoms and will often be requesting TREATMENT for these symptoms

Patients with hypochondriacal disorder will becomes fixed on their diagnosis and will often be requesting INVESTIGATIONS to help confirm this diagnosis

Question 8

What is body dysmorphic syndrome?

Answer 8

This is a specific type of hypochondriacal disorder where people become fixated with a specific part of their body and are convinced that it is abnormal or ugly e.g. hands or nose

Question 9

What is conversion/dissociative disorder?

Answer 9

This is where psychological pain is converted into a physical manifestation - (e.g. stress) often some form of loss of motor or sensory function

‘repressed memories’ are ‘converted’
into more acceptable and bearable physical symptoms ‘dissociating from what has happened’

Question 10

What are some common forms of conversion/dissosiative disorder?

Answer 10

E.g. Paralysis, blindness or sensory loss are all common manifestations

***remember that all features of somatisation, hypochondriacal disease and conversion disorder are involuntarily experienced unlike factitious disorder

Question 11

How does dissociation/conversion disorder differ form somatisation?

Answer 11

dissociation/conversion disorder has physical signs whereas somatisation has symptoms