Somatic Symptoms and Fictitious Disorders

Question 1

What are the criteria for a somatic symptom disorder?

Answer 1

1. 1+ somatic symptom - distressing/dysruptive
2. excessive thought, feeling or behavior related to symptom
3. persistent state of being symptomatic

Question 2

What is illness anxiety disorder?

Answer 2

it’s where you have a preoccupation with acquiring a serious illness - but NO somatic symptoms are present (just a high level of anxiety and excessive health-related behaviors)
preoccupation lasts 6 months

Question 3

What are the two subtypes of illness anxiety disorder?

Answer 3

care-seeking type and care-avoidant type

Question 4

Why is conversion disorder a difficult diagnosis to make?

Answer 4

you have to rule out any other possibilities

Question 5

Are rural or urban populations more likely to develop conversion disorders?

Answer 5

rural - may reflect local mores about to portray distress

Question 6

If conversion disorders occur in children, what is the usual presentaiton?

Answer 6

either gait problems or seizures

Question 7

Which gender is more likely to have conversion disorder? SES? IQ? ED?

Answer 7

women
lower SES, IQ, education

“less socially sophisticated”

Question 8

What are some examples of conversion disorder?

Answer 8

blindness, paralysis, dystonia, PNES, anesthesia, amnesia, unresponsiveness, swallowing problems, tics, hallucinations, pseudocyesis, camptocormia, clenched fish syndrome, pseudo foreign accent syndrome

Question 9

How does morbitity occur in the setting of conversion disorder?

Answer 9

often iatrogenic manifestation of unnecessary diagnosis and therapy

Question 10

What is the general treatment for all somatic disorders?

Answer 10

1. CBT (although insight therapy not really useful)
2. medication for comorbidities like antidepressants and antianxiety therapies
3. mindfulness therapies

Question 11

What is malingering?

Answer 11

it’s less of a diagnosis and more of a socially unacceptable behavior - faking symptoms for gain essentially

Question 12

When should you strongly suspect malingering?

Answer 12

1. medicolegal context
2. marked discrepancy between patient’s distress and objective findings
3. lack of cooperation during evaluation or treatment
4. antisocial personaltiy disorder

Question 13

What is the difference between malingering and factitious disorders?

Answer 13

malingering = behavior is done for an external motivation

factition disorder = behavior is to obtain medical treatment and evaluation

Question 14

What are the two types of factitious disorders?

Answer 14

1. imposed on self

2. imposed on another (proxy)

Question 15

What are the common risk factors for someone with a factitious disorder?

Answer 15

1. female, single, in her 30s
2. prior health care work (but generaly not a doctor)
3. cluster b personality with borderline symptoms

Question 16

What is the goal in factitious disorder?

Answer 16

generally just to be in the “sick role”

Question 17

Do most factitious disorder involve physical or psychological symptoms?

Answer 17

usually physical symptoms alone, but sometimes psychological

Question 18

What is the management for factitious disorders?

Answer 18

1. treat comorbid psychiatric issues
2. supportive psychotherapy - NOT contingent upon new physical symptoms
3. invasive diagnostics/treatment ONLY with objective evidence

Question 19

What should you keep on your DD for facitious by proxy?

Answer 19

1. pediatric somatization syndorme (it might actually be the kid)
2. infanticide/murder
3. psychosis in parent
4. just garden variety child abuse
5. malingering by child (school rejection)
6. an actual unrecognized physical disease

Question 20

Who is the most common perpetrator of factitious disorder by proxy?

Answer 20

usually the mother, against a preschool-age child (but not always)

Question 21

What are the common characteristics of someone who has factitious disorder by proxy?

Answer 21

1. chronic family dysfunction
2. pathological liar
3. considerable hospital experience

Question 22

Although gender and SES is equally represented in factitious disorder by proxy, what ethnic race is most common?

Answer 22

80% are caucasian!

Question 23

What percentage of muchausen kids die because of it? From what usually?

Answer 23

6-10%

apnea (smothering)

Question 24

What are the seven symptoms cateogies for factitious disorder by proxy?

Answer 24

1. exaggerations (i.e. migraines when HA)
2. false reports
3. falsification of signs (alter urine sample)
4. simulation of signs (teach kid to fake sx)
5. dissimulations (allow real illness to progress)
6. aggravation (rub dirt in cuts)
7. self-induced signs (injects child with bacteria)

Question 25

What is pseudocyesis?

Answer 25

false pregnancy