Somatic complaints

Question 1

How are physical pain and emotional pain intertwined?

Answer 1

1. Pain may cause psychological distress (e.g. depression, anxiety)
2. Psychological distress may worsen pain
3. In patients who were prevented from showing emotion (especially as children) may manifest their psychological distress as physical pain

Question 2

Name three DSM‐5 disorders in which psychological distress is the primary cause of the patient’s pain or other physical symptoms.

Answer 2

Somatic symptom disorder- disproportionate thoughts and behaviors associated with somatic symptom	
Conversion disorder- They are pseudo-neurological, but largely an expression of psychological distress	
Factitious disorder	(Munchausen syndrome)- symptoms are falsified for no apparent secondary gain. Primary gain is to get nurturing/care.

Question 3

Summarize the difference between factitious disorder and malingering

Answer 3

If they are falsifying symptoms for secondary gain

Question 4

Outline key points in a sensitive and effective interview of a patient with chronic pain

Answer 4

1. Ask about physical symptoms
2. Ask about impact of symptoms on their life, and express importance of effect of physical symptoms on emotional well-being
3. Ask about depression, anxiety, and any other psych symptoms.
4. Try to find out if any psych conditions predate or postdate their physical symptoms