Psychotherapy: 120b - Somatoform Disorders

Desire to have the role of the patinet (primary gain)

Remember: These patients are being unconsciously deceptive; they are not making a conscious effort to lie

(Vs. malingering, where goal is financial, legal - secondary gain)

No physical symtoms present in illness anxiety disorder

• Physical symptoms in SSD (upset stomach, pain, headache)

• Neurological symptoms in FND (can’t lift leg, facial droop)

• 1 or more brief episodes
  

  • If multiple episodes, symptoms vary

• May have psychological symptoms, physical symptoms, or both
  

  • May have real medical symptoms (may be self induced)

  • Pt has the unconscious goal of being the patient/being cared for as a patient

• Onset in early adulthood
  

  • Usually after hospitalization

• Rapid neurological symptom onset, rapid resolution
  

  • May be in the context of stress

• No neurologic cause (no stroke or motor neuron pathology)

• On exam, positive Hoover’s sign

Not intentionally produced or feigned by the patinet!

• Chartomegaly

• Complicated medial history of symptoms that don’t make sense

• Many work-ups, medical/surgical procedures, failed treatments

• Multiple allergies

• Popular, poorly understood diagnoses
  

  • Fibromyalgia, IBD

• Psychiatric history likely

• Demanding, histrionic, dramatic

• Seductive dress and manner

• Demanding behavior in the hospital
  

  • “Require” an abusable prescription b/c nothing else works

In factitious disorder, symptoms are usually variable and are intentionally produced with unconscious motivation

Unconsciously motivated by primary gain (to assume the sick role)

1/3 have comorbid neurological disorder in their lifetime

1/2 of non-epileptic seizure pts have epileptic seizures

Parent induces medical signs in a child with the purpose of assuming the sick role indirectly

(Munchausen’s is a severe form of factitious disorder)

May be some or all of the following; key takeaway is that there is a CNS pathology leading to the symptoms

• Altered connectivity between areas involved in emotion, memory, exec control, movement
  

  • Due to disturbances in brain networks

• Disruption in emotional processing
  

  • May be the link between psychosocial risk factors and neuro symptoms

Functional neurological disorder (previously conversion disorder)

Most extreme and notorious form of factitious disorder

• Life of hospitalizations

• Antisocial behavior

• Iatrogenic medical conditions

• Complex medical hx (w/ >average level of medical knowledge)

• Often in medical fields

In malingering, symptoms are usually consistent and are intentionally produced with conscious motivation

Patient is fabricating symptoms for financial or legal gain (secondary gain)