Somatoform Disorders (Somatic Symptom Disorder)

•    Definition:

o    One or more physical (somatic) symptoms that cause significant distress or disrupt daily life.

o    May or may not be associated with diagnosed medical conditions.

o    Excessive thoughts, anxiety, or behaviours related to symptoms.

•    Clinical features:

o    Persistent symptoms ≥6 months.

o    Frequent medical consultations without clear benefit.

o    May overlap with depression or anxiety.

•    Treatment:

o    Regular, scheduled GP follow-ups (avoid unnecessary investigations).

o    Focus on function rather than symptoms.

o    CBT effective in improving coping.

Conversion Disorder (Functional Neurological Symptom Disorder)

•    Definition:

o    Neurological symptoms (motor or sensory) incompatible with known neurological diseases.

o    Examples: sudden paralysis, non-epileptic seizures, blindness, gait disturbances.

•    Clinical clues:

o    Hoover’s sign: weakness improves with contralateral limb movement.

o    Non-dermatomal sensory loss.

o    La belle indifférence (apparent lack of concern) may be present but not diagnostic.

•    Treatment:

o    Reassurance that no structural disease found.

o    Physiotherapy, gradual rehabilitation.

o    Psychological support (avoid "all in your head" language).

Factitious Disorder

•    Definition:

o    Intentional falsification or induction of symptoms without obvious external rewards.

o    Motivated by desire to assume the "sick role".

•    Subtype:

o    Munchausen syndrome: severe, chronic form with frequent hospital visits, multiple scars from unnecessary procedures.

•    Features:

o    Inconsistent history, dramatic presentation.

o    May tamper with lab samples (e.g., adding blood to urine).

Illness Anxiety Disorder (Hypochondriasis)

•    Definition:

o    Preoccupation with having a serious illness despite medical reassurance and minimal or absent physical symptoms.

•    Features:

o    High health anxiety.

o    Excessive checking or avoidance (e.g., avoiding doctor due to fear).

•    Treatment:

o    Psychoeducation, CBT.

o    Avoid repeated reassurance (may reinforce anxiety).

Malingering

•    Definition:

o    Intentional feigning or exaggeration of symptoms for external gain, 

                                                                such as financial compensation, avoiding work, evading legal responsibility.

•    Key points:

o    Not considered a psychiatric disorder.

o    Often suspected when there is discrepancy between reported symptoms and objective findings.

Extra Revision Pearls

•    Conversion disorder symptoms are unconscious, unlike malingering (conscious and for gain) 

                                                                        and factitious disorder (conscious but no external reward).

•    Repeated negative investigations may reinforce somatoform disorders → "collusion of anonymity" if multiple specialists involved.

•    In illness anxiety disorder, the fear of disease predominates more than actual physical complaints.

•    Munchausen syndrome by proxy: now called factitious disorder imposed on another, 

                                                                        usually involves caregiver (often a mother) inducing illness in child.