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Overview of Somatic Symptom and Related Disorders

  • Involves disorders that manifest when symptoms do not align with medical or neurological conditions
  • Includes:
    • Somatic Symptom Disorder
    • Functional Neurological Disorder (Conversion Disorder)
    • Illness Anxiety Disorder
    • Factitious Disorder
    • Malingering

Methodological Approach to Diagnosing Disorders

  • Key Challenge: Disorders exhibit overlapping features with subtle differences
  • Categorization Approach: Dirty Medicine Flow Chart
    • Determine the nature of symptoms:
      • Are they experienced involuntarily or voluntarily?

Involuntary Symptoms

  • Three Disorders Corresponding to Involuntary Symptoms:
    1. Somatic Symptom Disorder
      • Involves true physical symptoms
    2. Functional Neurological Disorder (Conversion Disorder)
      • Involves neurological symptoms
    3. Illness Anxiety Disorder
      • Characterized by preoccupation with illness symptoms, often mild or absent
Somatic Symptom Disorder
  • Criteria:
    • Symptoms last at least 6 months
    • At least one real physical, non-neurological symptom
  • Key Characteristics:
    • Typically observed more in females
    • Patients undergo extensive diagnostic tests (CAT scans, MRIs, lab work)
    • Psychosocial impairment due to symptom worry
Illness Anxiety Disorder
  • Criteria:
    • Symptoms last at least 6 months
    • Patient is preoccupied with having a serious illness, despite mild or absent symptoms
  • Differentiation from Somatic Symptom Disorder:
    • Involves no actual physical symptoms, only anxiety about potential illness
    • Both conditions also share psychosocial impairment due to worry
Functional Neurological Disorder (Conversion Disorder)
  • Criteria:
    • At least one abnormal neurological sign or symptom
    • Symptoms not better explained by another diagnosis
    • Also involves psychosocial impairment due to symptom worry
  • Typical Patient Profile:
    • Ages 10-35
    • Symptoms include abnormal reflexes, motor/sensory disturbances

Voluntary Symptoms

  • Two Disorders Corresponding to Voluntary Symptoms:
    1. Factitious Disorder
    2. Malingering
  • Key Question to Differentiate:
    • Is the goal to assume the sick role (Factitious) or to gain secondary benefits (Malingering)?
Factitious Disorder
  • Criteria:
    • Patient falsifies symptoms to assume a sick role
    • Can be imposed on self or another (Factitious Disorder by Proxy)
  • Key Characteristics:
    • Often associated with personality disorders or significant personal history (e.g., abuse)
    • Patients may have healthcare experience, allowing for knowledge of methods to achieve symptoms
    • Example: A nurse who self-administers insulin to induce hypoglycemia
  • High-Yield Test Points:
    • Patients are dissatisfied with negative test results since they seek a diagnosis and care.
Malingering
  • Criteria:
    • Intentionally produces symptoms for secondary gain (financial benefits, escape from responsibilities, etc.)
  • Key Characteristics:
    • Typically more prevalent in males
    • Patients are often uncooperative and dissatisfied with negative test results
    • Example of Secondary Gain:
      • Faking a condition to receive disability payments or avoid jail time.

Summary of Key Distinctions

  • Involuntary Cases:
    • Somatic Symptom Disorder - at least one true physical symptom; patients often undergo multiple tests.
    • Illness Anxiety Disorder - lack of actual symptoms, patients express anxiety about mild or non-existent symptoms.
    • Functional Neurological Disorder - neurological symptoms present, often explained by psychological factors.
  • Voluntary Cases:
    • Factitious Disorder - intentional symptom creation to attain care or attention; may have mental health issues or healthcare knowledge.
    • Malingering - intentional symptom creation for personal gain; dissatisfaction with negative test results is a key indicator.