Lecture 25 - Somatization D/o and Malingering Flashcards Preview

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Flashcards in Lecture 25 - Somatization D/o and Malingering Deck (17):

what is the concept of somatization?

Concept: Somatization is the expression of psychological distress through bodily complaints


Somatic Symptom Disorder

Criteria for dx

how long does it have to latsed for?

Distressing somatic sx(s) that disrupt daily life ( symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder)

patient has persistent thoughts, anxiety, or devote excessive time to the symptoms or health concerns

6 months+


what may be associated with somatic symptom d/o?

An actual medical disorder - eg a patient had a low scale MI, and is now exhibiting symptoms and health concerns related to MI, but not caused by the MI,


Illness Anxiety disorder --

how is it different that somatic symptom disorder?

two specifier tpyes?

Patient has Preoccupation of having or acquiring serious illness

But Somatic symptoms are mild or absent

Excessive health behaviors

Not better explained by another disorder

> 6 months

care seekers vs care avoiders


Management of Somatic Symptom D/o and Illness Anxiety D/o

One primary physician
Regularly scheduled appts
Keep meds to a minimum
Address Co-morbidity
No cure, but can improve functioning --


• Conversion disorder (aka Functional Neurologic Symptom D/o)

Criteria --

symptoms of altered voluntary motor or sensory function

but...incompatibility between sxs and recognized neuro or medical d/o

not better explained by anothre medical disorder

significant distress or impairment


what are some manifestations that persons with conversion d/o might complain of?

paralysis, weakness
Sensory loss


Explain some Dx clues that could help rule our neurological or other medical process and lead towards dx of conversion d/o?

EEG of a non epileptic sz would be totally normal

Aphonia -- but the pt can cough

Paraplegic with intact reflexes

Comatose, but doesn't allow hand to fall on face

Hoover's sign


Some psycholical factors that might contribute to conversion d/o

Emotional stressor prior to onset

Model for symptoms (eg an epileptic patient who develops psuedoseizures)

h/o sexual abuse


Treatment of Conversion D/o

is the d/o conscious vs unconcious?

NON CONFRONTATIONAL reassurance, optimism, suggestion of stepwise improvement,

Resolve the psychosocial stressors; remove the secondary gain

Conversion – unconsciously produce the symptoms; ; not faking it; unconsciously driven


Factitious Disorder --

General definition -

Patient is consciously faking the disorder (eg purposeful infection, or injection of feces to become septic) in order to assume the sick role

but they don't have an objective rewards

Eg - conciously creating symptoms but unconsciously driven


Criteria for Facticious D/o

Falsification of physical or psychological signs or symptoms (self injury, surreptitious medication, eg injecting themselves with insulin)

• Trying to gratify dependency, masochism,
• A/w substance use, depression


what are the two subtypes of facticious and what are the difference?

Munchausen's syndrome -- "Hostpital Addicts, the wanderer" --- usually male, lots of hospital visits, vague and evasive histories, Leave AMA when found out

Non munchausen's type --
Females; non wandering; works in the health field
Leave AMA when found out


Making the dx of facticious d/o


○ The Diagnosis -- Gather collateral, room search, cross check hospital records

○ Management -- Establish rapport; present evidence; supportive confrontation; suggest psych eval


what is malingering ?

Conscious feigning of signs and symptoms for clearly identifiable external incentive or reward (avoid work, money, avoid prosecution, drugs)

consciously produced and consciously driven


• Body Dysmorphic Disorder (OCD Spectrum Disorder)


preoccupation with one or more perceived defects or flaws in physical appearance that are not observalable or appear slight to others

mirror checking, excessive grooming

causes significant distress and impaired functioning

○ Not meeting criteria for eating d/o


Treatment of • Body Dysmorphic Disorder (OCD Spectrum Disorder)

discourage surgery, SSRs, CBT,