A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years

A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms. This is an example of:

Munchausen’s syndrome13
Hypochondrial disorder
Dissociative disorder
Somatisation disorder
Conversion disorder

Unexplained symptoms

  • S omatisation = S ymptoms
  • hypo C hondria = C ancer

Important for meLess important

Somatisation disorder is the correct answer as the patient is concerned about persistent, unexplained symptoms rather than an underlying diagnosis such as cancer (hypochondrial disorder). Munchausen’s syndrome describes the intentional production of symptoms, for example self poisoning

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Unexplained symptoms

There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:

Somatisation disorder

  • multiple physical SYMPTOMS present for at least 2 years
  • patient refuses to accept reassurance or negative test results

Hypochondrial disorder

  • persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
  • patient again refuses to accept reassurance or negative test results

Conversion disorder

  • typically involves loss of motor or sensory function
  • the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
  • patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Dissociative disorder

  • dissociation is a process of ‘separating off’ certain memories from normal consciousness
  • in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
  • dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Factitious disorder

  • also known as Munchausen’s syndrome
  • the intentional production of physical or psychological symptoms

Malingering

  • fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain