Medically Unexplained Symptoms

Somatisation Disorder (SYMPTOMS)

This is a disorder where patients believe that have physical symptoms present for at least 2 years, despite no physical or organic explanation

– The most common symptoms mentioned usually involve the GI tract (abdominal pain) or the skin

– Patients don’t accept negative test results and instead feel great distress and worry over their symptoms

– It is more common in young women and can lead to multiple operations/investigations despite absence of disease

Hypochondrial Disorder (DISEASE)

This is a disorder where patients believe they have a serious underlying disease e.g. cancer, HIV, AIDS

– Similarly, to before, there is no physical or organic explanation

– Patients don’t accept negative test results and instead feel great distress and worry

– It is more common in men and people who have more contact with disease (e.g. health workers)

N.B. This is related to dysmorphophobia –> pre-occupation with imagined or small defect in physical appearance

– For example, patients can become worried about size of their nose, even though it is normal size

– This causes physical distress and can lead to great anxiety and avoidance behaviour.

Conversion Disorder (PHYSICAL SIGNS)

This is a condition in which a patient physical exhibits loss of motor or sensory function e.g. paralysis, numbness

– The patient doesn’t consciously fake the symptoms or try to exaggerate them but believes they are real

– However, the patient’s investigations will likely be normal, suggesting it is not due to a neurological condition

– Patients are typically aloof to their disorder and do not worry as much – called “la belle indifference”. This is key is helping distinguish between conversion and somatoform disorders.

Management:

– First exclude organic cause –> then therapies like hypnosis, psychotherapy, stress management

Dissociative disorders (PSYCHIATRIC SIGNS)

This is a group of conditions that involve disruptions or breakdowns in memory, awareness, identity or perception.

– In these disorders, psychiatric symptoms occur in the absence of pathology and these are more common in women

– According to the psychoanalytic view of psychiatry, painful memories are “cut-off” from conscious self and instead “converted” into more bearable

physical symptoms, called “primary gain”

Dissociative amnesia – A condition where the patient has no recollection of upsetting and personal information

– It is seen as a way to cope with previous emotional trauma

Dissociative fugue – A form of dissociative amnesia in which the patient flees away from their home

– They display amnesia for their identity, memories, personality and this can last hours to days

Dissociative identity disorder – This is the most severe form of dissociative disorder

– It is a condition where the patient develops multiple personalities which can take over.

– It is strongly linked to early childhood trauma e.g. sexual abuse

– Patient has amnesia for when the different personalities take over, but maybe aware of their existence

Management:

– First involves checking if there is an organic cause

– Psychotherapy (e.g. hypnosis) is main line to explore trauma and recall true identity 

Factitious Disorder/Munchausen’s syndrome (FAKE SYMPTOMS)

This is a condition where patients will produce physical or psychological symptoms to attain a patient’s role

– Patients can feign the symptoms, exaggerate them or deliberately hurt themselves to produce symptoms

– Typically, patients take hallucinogens, inject faeces to make abscesses and contaminate urine samples.

Management:

– Psychotherapy, family is also taught to condemn and not reward the patient’s behaviour

Malingering (FINANCIAL GAIN)

This is when a patient feigns or exaggerates their symptoms purely for a financial reward or other gain.

– Unlike before, it is not to play a patient’s role but to receive compensation, personal damages or get off work

– It is not a medical diagnosis, but can lead to a large economic burden on health care systems