Somatisation

Question 1

What defines a somatisation disorder?

Answer 1

• History of many physical complaints beginning before 30 y/o that occur over several years and result in treatment being sought or significant impairment in socio-occupational function
• Four pain symptoms AND two GI symptoms AND one sexual symptom AND one neurological symptom
• EITHER cannot be explained by a known medical condition or substance OR if there is a known condition causing these symptoms, they are in excess of what would be expected from Hx, Ex, Ix
• Not intentionally produced or feigned

Question 2

What defines conversion disorder?

Answer 2

• One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or GM condition
• Psychological factors are judged to be associated with the symptom or deficit (e.g. preceded by conflicts or stressors)
• Not intentionally produced or feigned
• Cannot after appropriate investigation, be fully explained
• Causes significant socio-occupational dysfunction
• Not limited to pain or sexual dysfunction, not exclusively during the course of somatisation disorder and not better accounted for by another mental disorder

Question 3

What defines hypochondriasis? What is the difference between it and malingering?

Answer 3

• Preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms
• Persists despite appropriate medical evaluation and reassurance
• Not of delusional intensity
• Causes significant socio-occupational dysfunction
• For at least 6 months
• Not better accounted for by another mental health condition
• Malingering is generally for identifiable gain

Question 4

What defines body dysmorphic disorder?

Answer 4

• Preoccupation with an imagined defect in appearance
• Causes clinically significant socio-occupational distress
• Not better accounted for by another mental disorder

Question 5

What defines factitious disorder? Which groups of people tend to present with this?

Answer 5

• Intentional production or feigning of physical or psychological symptoms
• Motivation is to assume the sick role
• External incentives are absent
• Common groups: health care employment, disturbed early attachments, early childhood illness, masochistic theme. Women outnumber men