Somatic symptom and related disorders

Somatic Symptom Disorder

• ♀ > ♂ 

• Complains of SX

• Pain, GI/GU, or neuro ssx that are unexplained and ➔ significant social/job problems

• Condition (not current complaint) >6mo

• TX is to schedule regular visits

Illness Anxiety Disorder

• ♀ = ♂ 

• Anxiety over the idea of an illness, SSX if present are mild

• Hx of personal/family serious illness as a child

• Fear/anxiety of having or developing medical problem ➔ spending time obsessing

• Multiple visits/work-ups or avoids getting admitted or screening tests

• Condition (not current complaint) >6mo

• TX is to schedule regular visits

Conversion Disorder (Functional Neurological Symptom Disorder)

• ♀ > ♂ 

• Less concerned about ssx

• Unexplained neuro SX (blindness, paralysis) that have inconsistent exam findings

• Hx of psychological stressor

• TX with CBT

Factitious Disorder 

• ♀ > ♂ 

• Deceptive behavior to get attention/sympathy (swallows a fork)

• Factitious disorder imposed on another (by proxy) - intentionally lie about or create ssx in another (child)

  • Call adult/child protective services

• DX  requires absence of obvious rewards (so NOT for money or getting out of commitment)

• TX is avoid work-up and CBT 

Malingering (not a disorder)

• Intentional reporting of sx for personal gain (money, time off work, get out of jail)

• Don't write malingering in chart