Related Subjects:
|Introduction to Psychiatry
|Assessment of the patient in Psychiatry
|Psychiatric Emergencies
|Depression
|Mania
|Schizophrenia
|Suicide
|Acute Psychosis
|Delusions
|General Anxiety Disorder
|Obsessive-Compulsive disorder
|Wernicke Korsakoff Syndrome
|Medically Unexplained symptoms
|Postpartum/Postnatal Depression
|Postpartum / Postnatal Psychosis
|Eating disorders in Children
📖 About
- Some patients present with physical symptoms for which no organic cause can be found.
These fall under a group of conditions often called somatoform and related disorders.
🤒 Somatisation Disorder
- Chronic condition with multiple physical complaints lasting ≥ 2 years.
- Symptoms cause significant impairment in functioning.
- No identifiable organic cause — symptoms are linked to psychological distress.
- Patients often reject reassurance or negative test results.
😟 Hypochondriacal Disorder (Illness Anxiety Disorder)
- Preoccupation with having a serious illness despite medical reassurance.
- Misinterpretation of normal bodily sensations.
- Symptoms persist for ≥ 6 months.
- Causes significant distress and functional impairment in daily life.
🧠 Conversion Disorder (Functional Neurological Symptom Disorder)
- Presents with loss of motor or sensory function (e.g., paralysis, blindness, non-epileptic seizures).
- Symptoms are not consciously produced.
- May show secondary gain (e.g., avoiding responsibilities).
- Classically associated with “la belle indifférence” — patient seems oddly unconcerned about serious symptoms.
🌀 Dissociative Disorders
- Involve a disruption of memory, consciousness, identity, or perception.
- Examples: amnesia, fugue states, stupor.
- Dissociative Identity Disorder (DID) — previously “multiple personality disorder” — most severe form.
🎭 Munchausen’s Syndrome (Factitious Disorder)
- Intentional production or feigning of physical/psychological symptoms.
- Motivation is to adopt the “sick role,” not external rewards.
💰 Malingering
- Deliberate exaggeration or fabrication of symptoms for external gain (e.g., money, avoiding military duty, obtaining drugs).
- Key difference from factitious disorder: clear external incentive.
Cases — Medically Unexplained Symptoms (MUS)
- Case 1 — Persistent pain 🩹: A 40-year-old woman presents with chronic widespread musculoskeletal pain, fatigue, and poor sleep. Extensive investigations (FBC, U&E, autoimmune screen, imaging) are normal. She describes fluctuating symptoms but is worried about “something serious.” Diagnosis: fibromyalgia / MUS. Managed with explanation, CBT, graded exercise, and amitriptyline for sleep disturbance.
- Case 2 — Neurological-type symptoms 🧠: A 28-year-old man reports sudden episodes of leg weakness and tremor, but neurological exam is inconsistent and MRI brain/spine are normal. He is distressed, unable to work, and fears multiple sclerosis. Diagnosis: functional neurological disorder (MUS subtype). Managed with clear explanation, physiotherapy, and psychology referral.
- Case 3 — Gastrointestinal complaints 🍽️: A 35-year-old woman presents with bloating, abdominal pain, and alternating bowel habit. Endoscopy and colonoscopy are normal, coeliac serology negative. Symptoms worsen with stress. Diagnosis: irritable bowel syndrome (IBS, functional GI disorder). Managed with dietary advice (low FODMAP), reassurance, and stress management strategies.
Teaching Point 🩺: MUS are common in primary and secondary care. The key is to validate symptoms without over-investigating, provide a clear explanation (“real symptoms, but not due to structural disease”), and use a biopsychosocial approach with CBT, physiotherapy, and lifestyle strategies.
