Psychiatry
Somatoform and Dissociative Disorders
Somatoform and dissociative disorders for MBBS and NEET-PG: somatisation, hypochondriasis, conversion, dissociative amnesia and fugue, and malingering, mapped to NMC codes PS10.
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Somatoform and Dissociative Disorders
Somatoform and dissociative disorders for MBBS and NEET-PG: somatisation, hypochondriasis, conversion, dissociative amnesia and fugue, and malingering, mapped to NMC codes PS10.
This chapter covers disorders in which psychological distress is expressed through physical symptoms or a disruption of consciousness and memory. It distinguishes somatisation, hypochondriasis and conversion from dissociative amnesia and fugue, separates these from factitious disorder and malingering, and sets out a management approach that avoids over-investigation.
High-yield: Somatoform and Dissociative Disorders
- Somatoform disorders present with physical symptoms that suggest a medical illness but are not fully explained by one, causing real distress.
- Somatisation disorder features multiple, recurrent physical complaints across many body systems over years.
- Hypochondriasis, or illness anxiety, is a persistent preoccupation with having a serious disease despite reassurance and normal investigations.
- Conversion disorder produces neurological symptoms such as paralysis, blindness or non-epileptic seizures that are not explained by disease.
- La belle indifference is a relative lack of concern about a disabling conversion symptom, though it is not diagnostic on its own.
- Dissociative disorders involve a disruption of the normal integration of memory, identity, perception or awareness.
- Dissociative amnesia is loss of memory for important personal information, usually of a stressful nature, beyond ordinary forgetfulness.
- Dissociative fugue is unexpected travel away from home with amnesia for the past and sometimes a new identity.
- Symptoms are typically preceded by psychological stress and are not intentionally produced, distinguishing them from factitious disorder and malingering.
- In factitious disorder symptoms are deliberately produced for the sick role, while in malingering they are produced for external gain.
- Organic disease must be carefully excluded before diagnosing a somatoform or dissociative disorder.
- Management centres on a consistent therapeutic relationship, limiting unnecessary investigations and avoiding reinforcement of illness behaviour.
- Cognitive behavioural therapy and treatment of any underlying depression or anxiety are the mainstays of care.
- Repeated reassurance alone rarely helps and can entrench the illness behaviour.
Key distinctions
- **Conversion disorder:** Neurological symptoms not explained by disease; may show la belle indifference.
- **Hypochondriasis:** Preoccupation with having a serious illness despite reassurance.
- **Dissociative amnesia and fugue:** Loss of personal memory, sometimes with travel and a new identity.
- **Factitious versus malingering:** Sick role in factitious disorder; external gain in malingering.
NMC competencies in this chapter
- **PS10.1:** Magnitude and aetiology of somatoform and dissociative disorders
- **PS10.2:** Clinical features of somatoform and dissociative disorders
- **PS10.3:** Indications and interpretation of investigations
- **PS10.4:** Treatment including behavioural methods
- **PS10.5:** Family education and specialist referral
- **PS10.6:** Pharmacological basis and side effects of therapies
- **PS10.7:** Distinguishing from factitious disorder and malingering
Frequently Asked Questions
What is conversion disorder?
It is a somatoform disorder in which psychological stress is expressed as neurological symptoms such as paralysis, blindness or non-epileptic seizures that are not explained by physical disease.
How do factitious disorder and malingering differ?
In factitious disorder symptoms are deliberately produced to take on the sick role, while in malingering they are produced for an external gain such as money, medication or avoiding duty.
What is dissociative fugue?
It is a dissociative disorder in which a person unexpectedly travels away from home with loss of memory for their past, sometimes assuming a new identity, usually triggered by severe stress.
How are these disorders managed?
Management uses a consistent therapeutic relationship, limits unnecessary investigations, treats any underlying depression or anxiety, and offers cognitive behavioural therapy rather than repeated reassurance.
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