Behav. Sci. Somatoform Disorders

Question 1

what are the unconscious productions of symptoms?

Answer 1

1. depressive/anxiety disorder

2. somatization disorder/somatic symptom disorder/conversion disorder

Question 2

what are the conscious productions of symptoms?

Answer 2

1. unconscious motivation (factitious disorder)

2. conscious motivation (malingering)

Question 3

what are the 7 somatoform disorders?

Answer 3

1. somatization disorder (somatic symptom disorder)
2. conversion disorder
3. hypochondriasis
4. body dysmporphic disorder
5. pain disorder
6. factitious disorder
7. malingering

Question 4

general characteristics of somatoform disorders

Answer 4

• involve both unconscious and social factors that may result in primary or secondary gain
• increased incidence in women (except hypochondriasis)
• tend to start in early adulthood and worsen with stress
• 50% have a co-morbid mental illness - anxiety, depression
• cause impairment in social and/or occupational function

Question 5

primary gain

Answer 5

internal/psychic motivations

Question 6

secondary gain

Answer 6

external motivations (need housing, disability, drugs, need to be cared for)

Question 7

etiology of somatoform disorders

Answer 7

• tend to run in families
• increased incidence of hypochondriasis and pain disorder with a family history of mood disorder or OCD
• maybe some serotonin-related gene pathways (hypofunction)

Question 8

somatization disorder

Answer 8

at least 4 or more pain issues (2 GI, 1 sexual, 1 neuro) - none can adequately be explained by medical causes after history

• onset before 30
• symptoms tend to be chronic and complete remission rare
• UNCONSCIOUS, NO SECONDARY GAIN

Question 9

conversion disorder

Answer 9

sudden and dramatic loss of one or more voluntary motor and/or sensory functions suggesting a neurologic etiology

• preceded by psychological stress or conflict (seeing something violet = blindness)
• self limited with remission in less than 1 month
• UNCONSCIOUS, NO SECONDARY GAIN

Question 10

what is a characteristic of conversion disorder?

Answer 10

patients are generally unaware of how the nervous system works and even though unconscious, their pseudoneurologic symptoms tend not to match the way nerves fire (wrong dermatomes, blindness, react to pain during seizure, pain radiates down)

Question 11

hypochondriasis

Answer 11

fear or idea of having a serious medical illness based on misinterpretation of bodily symptoms - now thought to be part of generalized anxiety disorder spectrum

• symptoms >6 months
• UNCONSCIOUS, NO SECONDARY GAIN

Question 12

body dysmorphic disorder

Answer 12

preoccupation with an imagined problem or insignificant abnormality in appearance -usually involving the face or head

• cannot be accounted for by an eating disorder
• UNCONSCIOUS, NO SECONDARY GAIN

Question 13

pain disorder

Answer 13

protracted pain that is severe enough to cause the patient to seek medical attention

• acute is less than 6 month, chronic is more
• 3rd or 4th decade
• can be disabling and cause dependence on pain meds
• UNCONSCIOUS, NO SECONDARY GAIN

Question 14

what are the great pretenders of many medical illnesses?

Answer 14

depression and anxiety

Question 15

management of somatoform disorders

Answer 15

• establish a strong doctor-patient relationship (regular short apts)
• identify and help to decrease social stressors and motivations for primary gain
• psychopharmacology for co-morbid depression depression and/or anxiety
• no medications really work idk
• symptoms recur when stress mounts

Question 16

factitious disorder

Answer 16

munchausen

• conscious feigning or production of phsyical or mental illness in order to receive attention from medical personnel “sick role”
• more common in people who work in the medical field
• tends to have a negative impact on work, school, and/or social functioning

Question 17

secondary gain in factitious disorder

Answer 17

feel proud, an expert, able figure things out that doctors cannot

Question 18

factitious disorder by proxy

Answer 18

parent feigns or induces illness in child (MC) to gain attention for him or herself
-CHILD ABUSE AND MUST BE REPORTED

Question 19

malingering

Answer 19

NOT a psychiatric illness: crime

• conscious simulation or exaggeration of physical or mental illness to achieve some sort of secondary gain (disability, drugs in ER, leave of absence/AWOL)
• symptoms improve as soon as the secondary gain is obtained
• seen more frequently in incarcerated and people involved in lawsuits

Question 20

best treatment for somatoform disorders, factitious disorders, and malingering

Answer 20

obtain records from everywhere, talk to as many providers and family members as possible, frequent focused medical visits (not psych ones), avoid over medicalizing or procedurizing the patient, have one managing PCP that must clear all procedures and referrals to specialists….simplify everything