Somatoform, Factitious, and Malingering - Vertrees Flashcards
group of illnesses characterized by physical symptoms that defy medical investigation
somatic symptom and related disorders
often undiagnosed
somatic symptom and related disorders
somatic symptom disorder
illness anxiety disorder
conversion disorder
somatic symptoms disorder
pt concerned about symptom
-distressing or disruptive
excessive thought, feeling, behavior related to it
at least 6 months
illness anxiety disorder
concern about further medical issue - not focus on symptom
preoccupied with having serious disease
- no somatic symptoms
- alarmed about health status
not to be reassured
excess health related behaviors or avoidance
duration 6 months or greater
tx of somatic sx and illness anxiety disorders
legitimize suffering
protect from iatrogenic harm
reinforce physician relationship without sx
conversion disorder
illness or voluntary motor/sensory symptoms
symptoms unconscious
clinical findings incompatible with recognized med/neuro condition
concurrent neuro diagnosis often
SSRI
in illness anxiety disorder
meds
for co-morbid psych disorder in somatic symptom disorder
person in car wreck, two people die, was driving, found - can’t move arms
conversion disorder
psych underlying cause
prognosis of conversion disorder
present acute
resolves weeks
more in females
la belle indifference
tx conversion disorder
benzos - acute tx only
book disagrees - but vertrees thinks so
factitious disorder
two types:
- imposed on self
- imposed on another (munchausen by proxy)
factitious disorder
voluntary production of sign, symptoms, disease
unconscious motivation
do recognize they are creating symptoms
often in medical professionals
goal tx factitious disorder
obtain role of patient
primary gain - care and attention
secondary gain - tangible life benefits - make money from selling pills they get
factitious disorder associations
personality
-borderline
typically young female
- high socioeconomic status
- intelligent, educated, med related fields
factitious disorder imposed on another
other - child or elder
perpetrator - mother or daughter
management of factitious disorder
consider pt rights/informed consent
emphasize degree of emotional distress
emphasize behavior must reflect difficulty in communicating needs
malingering
intential production of sx and intentional motivation
secondary gain
- financial
- avoid military service
- avoid criminal prosecution
- obtain controlled substances
- obtain shelter
factitious
conscious illness production
unconscious motive
malingering
conscious illness production and motivation
somatic symptom disorder
illness anxiety disorder
conversion disorder
unconscious illness production
unconscious motive
primary psychologic gain
factitious
secondary gain
malingering
tx of factitious
supportive therapy
lack of concern
conversion disorder
conversion
in women - more in combat vets
tx of conversion disorder
benzos, relax therapy, do nothing
tx of conversion disorder
benzos, relax therapy, do nothing
body dysmorphic disorder
now grouped with OCD