Somatoform Disorders Overview

Introduction

• Continuation from previous video on somatic symptom disorder.
• Focus on illness anxiety disorder, conversion disorder, factitious disorder, and malingering.

Illness Anxiety Disorder

• Previously known as hypochondriasis, now considered part of OCD spectrum disorders.
• Key features involve obsessional preoccupation with having a serious illness.
  • Example: Headache perceived as brain cancer.
• Distinction from somatic symptom disorder: Focus on belief of illness, not symptoms.
• Presentation:
  • Compulsive health-related behaviors: extensive research, self-checks.
  • Avoidance or frequent medical visits.
  • Negative test results increase anxiety rather than reassurance.
• Similar to OCD: Obsessive thoughts and compulsive actions.
• Prevalence: ~0.5% of the population, equally affects men and women.
• Treatment: CBT as first-line, serotonin-boosting medications effective.

Conversion Disorder (Functional Neurologic Disorder)

• Involves medically unexplained neurologic symptoms.
• Key idea: Patients genuinely can't perform functions, not faking.
• Symptoms: Blindness, loss of sensation, speech issues, tremors.
• Often without recent stressor, unlike historical DSM requirement.
• Prevalence: Common in neurology clinics, more diagnosed in women.
• Prognosis: Good for neurologic deficit, less so for broader symptoms.
• Treatment: Education, physical therapy for motor deficits. Avoid confrontation.
• Viewed as dissociative disorder due to shared features.

Factitious Disorder

• Intentionally faking symptoms for primary gain (sympathy, attention).
• Known formerly as Munchausen syndrome.
  • Example: Feigning illness to receive hospital care.
  • Includes self-harm for sustaining sick role.
• Factitious disorder imposed on another: Parent harming child for attention.
• Difficult to diagnose definitively, use mnemonic "FRACTITIOUS" for clues.
• Rare, often affects medical workers, poor prognosis, high comorbidities.
• Treatment challenging, no clear consensus on confrontation.

Malingering

• Feigning illness for secondary gain (disability payments, lighter sentences).
• Not a mental disorder; motivated by external benefits.
• Use mnemonic "SHAM" for recognizing malingering.
• Management: Open-ended questions, avoid emotional reactions, connect to resources.

Key Differences Between Factitious Disorder and Malingering

• Mnemonic: MALingerers LEAVE after getting what they want; FACTitious come BACK for more.

Conclusion

• Addressed major conditions with medically unexplained symptoms.
• Encourage practicing with related questions for better understanding.
• Feedback and further learning suggested.