Somatic Symptom & Related Disorders + Nonadherence to Medical Treatment

what is factitious disorder?

a condition in which a person, without a motive or reward, acts as if they have an illness by deliberately producing, feigning or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role

what is munchausen syndrome?

factitious disorder imposed on self (by proxy = imposed on another person)

- the patient falsifies physical or psychological symptoms or induces injury or disease to themselves

how is factitious disorder treated?

- confrontation by PCP & psychiatrist

- if imposed on another (by proxy), children must be removed by child protective services

what is illness anxiety disorder (hypochondriasis)?

patient's are worried about having or developing a serious illness & the preoccupation is present for at least 6 months

- & is NOT better explained by another mental disorder (ex: OCD & somatic symptom disorder)

how is illness anxiety disorder treated?

- group/insight oriented therapy

- regular appts w/ a provider for reassurance

- meds (SSRIs if concurrent/underlying anxiety or MDD)

what is somatic symptoms disorder?

patient experiences > 1 somatic symptom(s) which are distressing to the patient or leads to significant amount of disruption in the patient's life

- experiences excessive thoughts, feelings, and behaviors in relation to their somatic symptoms or their health concerns

- symptoms must be persistent for >/= 6 months (although these symptoms don't always have to be present)

how is somatic symptom disorder treated?

have a single clinician as the designated primary care taker

- schedule monthly visits & psychotherapy

- avoid unnecessary diagnostic testing unless indicated

patient consciously reports false symptoms, or induces symptoms, with the goal of playing the "sick role" =

factitious disorder

obsession with the idea of having a serious but undiagnosed medical condition =

illness anxiety disorder

preoccupation with having a serious illness =

somatic symptoms disorder

25y/o female presents today w/ multiple complaints that have been ongoing for more than 6 months. She reports that “it all started about 10 months ago with pain in my neck, shoulders, back, legs, and feet.” She denies any trauma. There is no family hx of juvenile rheumatoid arthritis or osteoarthritis. She stated that the pains do not respond to treatments, and they “just come and go making it difficult to hold a job.” She is constantly worried about her symptoms. Now, she has a headache, abdominal pain, bloating and “some seizures.” She previously had seen a headache specialist, gastroenterologist, and obtained a number of electrocardiograms in the emergency department. Their respective thorough workup was negative. Her mother had similar episodes as well. On physical exam, you note an anxious woman with a depressed affect. No significant physical exam findings are noted. Labs/imaging are all within normal range.

somatic symptom disorder

a 25-year-old male graduate engineering student who is at your office for the fourth time in 1 week to be sure he does not have chlamydia. Despite having one sex partner, he learned there is an increase in the incidence of STDs on campus. He reports that he has only had sex once but learned that chlamydia is hard to culture. He reports he may have dysuria intermittently but is not sure. He has been evaluated at each visit, and physical and laboratory examination has been completely normal each time.

illness anxiety disorder

a 35-year-old female with c/o palpitations and chest pain for 2 days. She reports that she had been sweating with nausea and vomiting. She reports that she “checked her pulse which was about 156.” She denies any personal or family history of heart disease or anxiety disorders. She rated her chest pain as 10/10 “which radiates down my left arm and up my jaw.” ECG reads normal sinus rhythm. Troponin, CKMB and other labs were normal. When she was told that her labs were normal, she flopped onto the bed and started “seizing.” She stated, “I am seizing. Why won’t you help me?” When the ER PA calls her out, she got angry and left against medical advice.

factitious disorder