Somatoform Disorders

Question 1

What is the DSM criteria for Somatization Disorder?

Answer 1

>4 pain issues

• 2 GI
• 1 Sexual
• 1 Neurological

Onset before 30 yo

Chronic Syx

Unconscious, no secondary gain, patient unaware of behaviors/Syx generation, not concerned or worried

Question 2

What is the DSM criteria for conversion disorder? How long does this condition generally last?

Answer 2

Sudden and dramatic loss of voluntary motor/sensory function preceded by psych stress/conflict; Patients are aware of their condition but are indifferent to their situation; Last for < 1 month; Patient is unaware of any scondary gains

Question 3

Patients generally don’t know how the nervous system works. What might be some red flags in terms of symptoms?

Answer 3

• Wrong dermatomes for sensory loss
• Blindness still has optokinetic effect
• During seizure can react to pain or sneeze
• Pain radiates down instead of up
• In seizures movements are vertical, not horizontal

Question 4

What is hypochondriasis? Duration of Syx for Dx?

Answer 4

Fear or idea of having a serious medical illness based on misinterpretation of bodily Syx; Persists even after negative medical findings; > 6 months; Unconscious, no secondary gain, patient unaware of behavior/Syx generation, very concerned and worried

Question 5

What is body dysmorphic disorder? Typical patient profile?

Answer 5

Preoccupation with an imagined problem or insignificant abnormality in appearance; Cannot be accounted for by an eating disorder; Unconscious, no sec. gains, patient unaware of behaviors/syx generation, very concerned/worried

Question 6

What is pain disorder? Duration? Onset? Patient profile?

Answer 6

Protracted pain that is severe enough to cause patient to seek medical attention, not explained by physical causes; Acute (< 6months), Chronic (>6 months); 3rd/4th decade; Unconscious, no secondary gain, patient unaware of behaviors/Syx generation, very concerned/worried

Question 7

How are unconscious somatoform conditions treated?

Answer 7

Regular, short appointments, constant reassurance, empathy, Decrease social stressors; SSRIs for comorbid conditions, Hypnosis, Psychotherapy, Interpersonal/Cognitive behavioral therapy

Question 8

What is factitious disorder?

Answer 8

Conscious feigning or production of physical or mental illness in order to receive attention from medical personnel

Question 9

What is factitious disorder by proxy?

Answer 9

Creating a medical condition in someone else (injecting insulin into a child) to gain attention for him/herself

Question 10

Commonly feigned/produced Syx?

Answer 10

• Abdominal pain
• Fever
• Hematuria
• Seizures
• Skin Lesions
• Tachycardia
• Hypoglycemia
• DVT

Question 11

What is malingering?

Answer 11

Conscious simulation or exaggeration of physical or mental illness to achieve some sort of secondary gain:

• Drugs
• Disability
• Leave of absence

Syx improve as the secondary gain is obtained