Flashcards in Somatic Symptoms and Fictitious Disorders Deck (25):
What are the criteria for a somatic symptom disorder?
1. 1+ somatic symptom - distressing/dysruptive
2. excessive thought, feeling or behavior related to symptom
3. persistent state of being symptomatic
What is illness anxiety disorder?
it's where you have a preoccupation with acquiring a serious illness - but NO somatic symptoms are present (just a high level of anxiety and excessive health-related behaviors)
preoccupation lasts 6 months
What are the two subtypes of illness anxiety disorder?
care-seeking type and care-avoidant type
Why is conversion disorder a difficult diagnosis to make?
you have to rule out any other possibilities
Are rural or urban populations more likely to develop conversion disorders?
rural - may reflect local mores about to portray distress
If conversion disorders occur in children, what is the usual presentaiton?
either gait problems or seizures
Which gender is more likely to have conversion disorder? SES? IQ? ED?
lower SES, IQ, education
"less socially sophisticated"
What are some examples of conversion disorder?
blindness, paralysis, dystonia, PNES, anesthesia, amnesia, unresponsiveness, swallowing problems, tics, hallucinations, pseudocyesis, camptocormia, clenched fish syndrome, pseudo foreign accent syndrome
How does morbitity occur in the setting of conversion disorder?
often iatrogenic manifestation of unnecessary diagnosis and therapy
What is the general treatment for all somatic disorders?
1. CBT (although insight therapy not really useful)
2. medication for comorbidities like antidepressants and antianxiety therapies
3. mindfulness therapies
What is malingering?
it's less of a diagnosis and more of a socially unacceptable behavior - faking symptoms for gain essentially
When should you strongly suspect malingering?
1. medicolegal context
2. marked discrepancy between patient's distress and objective findings
3. lack of cooperation during evaluation or treatment
4. antisocial personaltiy disorder
What is the difference between malingering and factitious disorders?
malingering = behavior is done for an external motivation
factition disorder = behavior is to obtain medical treatment and evaluation
What are the two types of factitious disorders?
1. imposed on self
2. imposed on another (proxy)
What are the common risk factors for someone with a factitious disorder?
1. female, single, in her 30s
2. prior health care work (but generaly not a doctor)
3. cluster b personality with borderline symptoms
What is the goal in factitious disorder?
generally just to be in the "sick role"
Do most factitious disorder involve physical or psychological symptoms?
usually physical symptoms alone, but sometimes psychological
What is the management for factitious disorders?
1. treat comorbid psychiatric issues
2. supportive psychotherapy - NOT contingent upon new physical symptoms
3. invasive diagnostics/treatment ONLY with objective evidence
What should you keep on your DD for facitious by proxy?
1. pediatric somatization syndorme (it might actually be the kid)
3. psychosis in parent
4. just garden variety child abuse
5. malingering by child (school rejection)
6. an actual unrecognized physical disease
Who is the most common perpetrator of factitious disorder by proxy?
usually the mother, against a preschool-age child (but not always)
What are the common characteristics of someone who has factitious disorder by proxy?
1. chronic family dysfunction
2. pathological liar
3. considerable hospital experience
Although gender and SES is equally represented in factitious disorder by proxy, what ethnic race is most common?
80% are caucasian!
What percentage of muchausen kids die because of it? From what usually?
What are the seven symptoms cateogies for factitious disorder by proxy?
1. exaggerations (i.e. migraines when HA)
2. false reports
3. falsification of signs (alter urine sample)
4. simulation of signs (teach kid to fake sx)
5. dissimulations (allow real illness to progress)
6. aggravation (rub dirt in cuts)
7. self-induced signs (injects child with bacteria)