Somatic Symptoms And Related Disorders; Nonadherence To Medical Treatment

Question 1

Factitious disorder

Answer 1

• intentional falsification or exaggeration of signs and symptoms of medical or psychiatric illness for primary gain
  
  • motivation is assuming sick role to get sympathy
• inner need to be seen as ill or injured, but not for concrete personal gain (as seen in malingering)
• deliberately fake symptoms (main difference from somatic symptom disorder)
• may suffer from other mental disorders (personality disorders)

Question 2

Factitious disorder- types

Answer 2

1. Imposed on self
   
   • presents as injured, impaired, or ill
2. Imposed on another (by proxy)
   
   • presents another as injured, impaired, or ill (child, elder, or mentally disabled family member)
   • form of premeditated child or elder abuse

Question 3

Factitious disorder- symptoms

Answer 3

• creation or exaggeration of symptoms of illness
  
  • may hurt themselves to bring on symptoms, alter diagnostic tests, lie, or mimic symptoms
  • may inject themselves with substances to make sick
  • medical history may be dramatic, but inconsistent
• may be willing or eager to undergo surgery repeatedly or painful tests in order to obtain sympathy
  
  • may hospital jump, use other aliases, or go to different cities to access care
  • have extensive knowledge about medical terminology, hospitals, or great detail about illness (may even work in healthcare)

Question 4

Factious disorder- management

Answer 4

-nonspecific treatment

Question 5

Munchausen syndrome

Answer 5

• old term that referred to severe form of factitious disorder
• predominance of physical symptoms, use of aliases, habitual lying

Question 6

Illness anxiety disorder

Answer 6

-formerly hypochondriasis

• preoccupation with fear or belief one has or will contract a serious, undiagnosed disease (despite reassurance and medical workups)
• at least 6 months
• somatic symptoms not present, or mild in intensity
• age 20-30
• care seeking type- frequently get tested, doctor shop
• care avoidance may be seen

Question 7

Illness anxiety disorder-management

Answer 7

-regularly scheduled appointments with medical provider for continued assurance

Question 8

Somatic symptom disorder

Answer 8

-formerly somatization disorder

• chronic condition
• physical symptoms involving 1 or more part of body, but no physical cause found
• MC in women
• onset= before age 30
• many previously diagnosed with hypochondriasis

Question 9

Somatic symptom disorder- criteria

Answer 9

• 1 or more vague somatic symptoms that are distressing or results in significant disruption of daily life
  
  • cannot be explained by physical or medical cause
• 2 or more means high likelihood of somatization disorder:
  
  • SOB- respiratory
  • dysmenorrhea- reproductive
  • burning in sexual organ- psychosexual
  • lump in throat (dysphagia)- pseudo neurological
  • amnesia- pseudo neurological
  • vomiting- GI
  • painful extremities- skeletal muscle
• mnemonic= Symptoms Described as Body Laments and Ailments Void a Physical cause

Question 10

Somatic symptom disorder- symptoms

Answer 10

• excessive thoughts, feelings, or behaviors related to somatic symptoms
  
  • disproportionate and persistent thoughts about seriousness of symptoms
  • persistently high level of anxiety about symptoms or health
  • excessive time and energy devoted to symptoms and health concerns
• state of being symptomatic is persistent (>6 months)
• may or may not be associated with other medical conditions

-specifiers: with predominant pain (previously pain disorder in DSM IV)

Question 11

Somatic symptom disorder- management

Answer 11

• regularly scheduled visits to healthcare provider

- reticent to seek mental health counseling