Somatoform and Factitious Disorders

Question 1

What are primary and secondary gain?

Answer 1

• symptoms for primary gain are an unconscious defense against unacceptable internal conflicts
• symptoms for secondary gain are used to achieve external benefits

Question 2

What is somatization disorder and how is it managed?

Answer 2

• it consists of multiple, often nonspecific, physical symptoms involving many organ systems
• these are not intentionally produced and cause concern and anxiety for the patient
• management includes having regular visits with a single PCP who can limit and direct appropriate medical workups

Question 3

Describe the features and treatment of conversion disorder.

Answer 3

• these patients have at least one neurologic symptom with a sudden onset usually preceded by a psychological stressor
• patients are typically very calm and unconcerned
• treat with psychotherapy, hypnosis, or relaxation therapy; the physical symptom will typical abate spontaneously

Question 4

What is hypochondriasis and how is it treated?

Answer 4

• it is a preoccupation with the fear of having or contracting a serious disease that persists for at least 6 months
• management includes CBT and regularly scheduled visits with a single PCP to limit medical testing

Question 5

What is body dysmorphic disorder and how is it treated?

Answer 5

• it is a preoccupation with a particular body part and a perception that it is flawed, defective, or unattractive
• patients are very self-conscious and spend significant time trying to correct these perceived flaws
• the best treatment is an SSRI; surgical or dermatological procedures are not usually helpful in pleasing the patient

Question 6

What is factitious disorder?

Answer 6

these patients intentionally produce medical or psychological symptoms in order to assume the role of a sick patient (primary gain)

Question 7

What distinguishes factitious disorder from malingering?

Answer 7

those with factitious disorder produce their symptoms for primary gain whereas those who malinger do so for secondary gain

Question 8

What is the key aspect of the each of the following:

• somatoform disorder
• factitious disorder
• malingering
• Munchhausen syndrome

Answer 8

• somatoform disorder: patients truly believe their own symptoms
• factitious disorder: patients fake for primary gain
• malingering: patients fake for secondary gain
• Munchhausen syndrome: another name for factitious disorder