10. Somatoform and Factitious d/os

Question 1

What is the primary gain in somatoform disorder?

Answer 1

unconscious defense against unacceptable INTERNAL conflicts (ex. self-justification for various actions/lack of actions)

Question 2

What is the secondary gain in somatoform disorder?

Answer 2

Symptoms that provide unconscious EXTERNAL benefits (ex. attn from others, less responsibilities, avoidance of law)

Question 3

What are 5 examples of somatoform disorders?

Answer 3

1. Somatization disorder
2. conversion d/o
3. Hypochondriasis
4. Pain d/o
5. Body dysmorphic d/o

Question 4

What are common comorbid mental disorders associated w/ somatoform d/o? (2)

Answer 4

anxiety disorders, major depression

Question 5

DSM criteria of somatization d/o (5)

Answer 5

1. onset BEFORE age 30
2. at least 4 pain symptoms
3. at least 2 GI symptoms
4. at least 1 sexual/repro symptoms
5. at least 1 pseudoneurological symptom (not limited to pain)

Question 6

Incidence of somatization d/o in M vs F?

Answer 6

Females have 5-20x higher incidence

Question 7

Prognosis of somatization d/o?

Answer 7

Chronic and debilitating

- symptoms may periodically improve and worsen under stress

Question 8

Treatment of somatization d/o?

Answer 8

• regularly scheduled visits with a SINGLE pcp (who limits, but does not eliminate medical workup)
• address psychological issues slowly (will likely resist referral to a mental health professional)

Question 9

What’s the one somatoform d/o that doesn’t have a higher freq in women?

Answer 9

Hypochondriasis

Question 10

DSM criteria for conversion d/o?

Answer 10

• at least 1 neurological symptom (sensory/motor)
• psychological factors associated w/ initiation or exacerbation of symptoms
• not intentionally feigned or produced

Question 11

Common symptoms of conversion d/o?

Answer 11

shifting paralysis, blindness, mutism, paresthesias, seizures, global hystericus (sensation of lump in throat)

Question 12

Tx of conversion d/o

Answer 12

• insight-oriented psychotherapy
• hypnosis
• relaxation tx
• NOTE: most pts spontaneously recover

Question 13

Prognosis of conversion d/o

Answer 13

• most pts spontaneously recover
• symptoms may be brief or last wks or longer
• 25% will have future episodes (esp during times of stress)

Question 14

How long must symptoms last to be diagnosed as hypochondriasis?

Answer 14

6 months

Question 15

Tx for hypochondriasis?

Answer 15

CBT (most useful of the psychotherapies for hypochondriasis)

Question 16

Prognosis of hypochondriasis?

Answer 16

• episodic (symptoms may wax and wane periodically)

- exacerbations under stress

Question 17

What % of hypochondriacs have coexisting psych illness?

Answer 17

80% have coexisting MDD or anxiety disorder

Question 18

Treatment for body dysmorphic d/o?

Answer 18

SSRIs may reduce symptoms in 50% of pts

Question 19

Prognosis of body dysmorphic d/o?

Answer 19

• Onset is gradual

- symptoms may be chronic OR wax/wane

Question 20

Avg age of onset of pain d/o?

Answer 20

30-50

Question 21

Treatment of pain d/o? (4)

Answer 21

SSRIs, biofeedback, hypnosis, psychotherapy

Question 22

Are analgesics helpful for pain d/o?

Answer 22

No - pts often become dependent on them

Question 23

Prognosis of pain d/p?

Answer 23

increase in intensity for 1st several months, and often becomes chronic and disabling

Question 24

What is factitious d/o?

Answer 24

Pts who INTENTIONALLY produce medical or psychological symptoms in order to assume the role of a sick patient

Question 25

What is a distinguishing factor b/w factitious d/o and malingering?

Answer 25

Lack of secondary gain in factitious d/o

Question 26

Epidemiology of factitious d/o (4)

Answer 26

• Associated w/ higher intelligence, poor sense of identity, poor sexual adjustment
• h/o child abuse or neglect