Somatisation and hypochondriacal disorders – F45 Flashcards
What are the main features of somatisation and hypochondriacal disorders?
Repeated presentation of physical symptoms with persistent requests for medical investigations in spite of repeated negative findings and reassurances by doctors that the symptoms haven no physical basis
What is somatisation disorder?
Multiple, recurrent, frequently changing symptoms of at least 2yrs duration; If occurs for less than 2yrs = undifferentiated somatoform disorder
Long complicated history with medical profession – negative findings
Chronic and fluctuating disorder; disruption of social/interpersonal/family relationships
What is hypochondriacal disorder?
Persistent preoccupation with having one or more serious and progressive physical disorder
May manifest physical complaints or persistent preoccupation with appearance
Normal/commonplace sensations and appearances perceived as abnormal and distressing
Marked anxiety and depression usually often present too
What is somatoform autonomic dysfunction?
Symptoms seems to reflect physical disorder of system/organ completely under autonomic control
Complaints of objective signs of autonomic arousal i.e. sweating, palpitations, tremor, fear and distress at the possibility of having a physical disorder etc
Complaints of subjective, non specific, fleeting/changing sensations i.e. aches/pains, burning, heaviness, tightness etc relating to a specific system
What is persistent somatoform pain disorder?
Predominant complaint is persistent, severe and distressing pain which cannot be explained fully by physiology
Co occurs with emotional conflict or psychosocial problems that are sufficient to allow the conclusion they are the main causative influences
How do you treat somatisation and hyperchondriacal disorders ?
Psychotherapy - if the patient is able to admit they have a problem
What is Munchausen’s syndrome?
A psychological disorder where an individual pretends to be ill or deliberately produces illness in themselves
To assume the ‘sick role’ and have people care for them
Named after a character created by Rudolf Erich Raspe - a German aristocrat Baron Munchausen who told wild unbelievable tales about his exploits (like he travelled to the moon or escaped from drowning by pulling his own hair)
What is some epidemiology of Munchausen’s?
2 key demographics:
Women aged 20-40 with a background in healthcare i.e. nurse or medical technician
Unmarried white men aged 30-50
What is the aetiology of Munchausen’s?
Emotional trauma or illness in childhood that lead to extensive medical attention
Parental neglect/abandonment
i) Compulsions to punish selves as feel unworthy
ii) Need to feel important and be the centre of attention
iii) Need to pass responsibility of wellbeing onto someone else
Personality disorder - links to antisocial, borderline and narcissistic PDs
Grudges against authority figures or healthcare professionals – we don’t really know though
How does Munchausen’s present?
Faking psychological symptoms – claiming to hear voices or see things that aren’t there
Faking physical symptoms – claiming to have chest pain or stomach aches
Actively trying to get ill – deliberately infecting a wound by rubbing dirt into it
Frequent attendances to hospitals, demanding unnecessary investigations and even life threatening surgeries, then fleeing to other hospitals if they are exposed
Manipulative
How do you investigate Munchausen’s?
Check health record for inconsistencies between actual and claimed medical history
Contact patients families about patient
Can be confidently diagnosed if: clear evidence of symptom fabrication + person’s prime motivation to be seen as sick + no other likely explanation for behaviour
How do you treat Munchausen’s?
Psychoanalysis + CBT
What is Fabricated or Induced Illness (FII) or Munchausen’s by proxy?
Rare form of child abuse – usually to children under 5 by the child’s mother (90%) – deliberately causes illness symptoms in their child:
Persuades health care professionals that their child is ill when they’re perfectly healthy
Exaggerates/lies about child’s symptoms
Manipulates tests to show presence of illness i.e. adding glucose to urine to suggest child has diabetes
Deliberately inducing symptoms i.e. via poisoning her child
How common is FII?
Rare - C. 89/100,000 cases estimate but probably higher
What conditions are commonly comorbid with FII?
Personality disorders, somatoform disorders and Munchausen’s
