Somatic Symptom

and Related
Disorder

Presented By:
Aqsa Mushtaq (
Shaheena Jamil (10163)
 Table of Contents

1 Introduction
4 Differential Diagnosis

2 Diagnosis Criteria
5 Research Articles Published

3 Etiology
6 Conclusion
Introduction

Somatic Disorder
 3
Functional Neurological
Symptom Disorder
(Conversion Disorder)

The term "conversion" refers to the idea of

psychoanalytical theory which suggests that the symptoms
in conversion disorder may be a result of the unconscious
mind's attempt to express emotional distress or conflicts
that the individual is unable to confront consciously.
 Etiology
The etiology of Functional Neurological Symptom Disorder is complex and
multifactorial, involving a combination of psychological, social and biological
factors that converge to produce the symptoms. Predisposing factors include
adverse life events, childhood trauma, emotional distress, and suggestibility,
while perpetuating factors include secondary gain, avoidance of unpleasant
emotional states, and reinforcement of the sick role.
 Diagnostic Criteria

A C
One or more Symptom is not better
symptoms of altered explained by another
medical or mental
voluntary motor or
disorder
sensory function.
D
B Symptom causes
Clinical findings
provide evidence of clinically significant
incompatibility distress in social,
between the symptom occupational, or other
and recognized important areas
neurological or
medical conditions
Association With Suicidal Thoughts or
Behavior
Cohort studies of functional neurological symptom disorder mostly
show higher rates of suicidal thoughts and attempts. Individuals with
functional symptoms in a neurology clinic have a higher rate of
suicidal thoughts than individuals with recognized neurological
disease
 Differential Diagnosis

Recognized Neurological Dissociative disorders

disease Dissociative symptoms are common in
Thorough neurological assessment, an
individuals with functional neurological
unexpected neurological disease cause for
symptom disorder. If both functional
the symptoms is rarely found at follow-up.
neurological symptom disorder and a
However,
dissociative disorder are present, both
reassessment may be required if the
diagnoses should be made
symptoms appear to be progressive.

Depressive disorders Panic disorder

Episodic neurological symptoms (e.g., tremor
and paresthesia) can occur in both functional
Individuals may report general heaviness of neurological symptom disorder and panic
their limbs, whereas the weakness of attacks.
functional neurological symptom disorder is In panic attacks, the neurological symptoms are
more focal and prominent. Depressive associated with characteristic cardiorespiratory
disorders are also differentiated by the symptoms and retained awareness.
presence of core depressive symptoms. Loss of awareness with amnesia for the attack
occurs in functional seizures but not in panic
attacks.
 Differential Diagnosis

Body dysmorphic disorder Somatic symptom disorder

Functional neurological symptom disorder
Individuals with body dysmorphic disorder may be diagnosed in addition to somatic
are excessively concerned about a perceived symptom disorder. Most of the somatic
defect in their physical appearance but do symptoms encountered in somatic symptom
not complain of symptoms of sensory or disorder cannot be demonstrated to be
motor functioning in the affected body part clearly incompatible with recognized
neurological or medical disease, whereas in
functional neurological symptom disorder,
such incompatibility is required for the
Factitious disorder and Malingering diagnosis.

Functional neurological symptom disorder describes

genuinely experienced symptoms that are not intentionally
produced (i.e., not feigned). However, evidence of
feigning would suggest malingering if the individual’s
apparent aim is to obtain an obvious external reward, or
factitious disorder in the absence of such reward.
 Factitious Disorder
4
Factitious disorder is a mental disorder in which a person acts
as if they have a physical or mental illness when they do not.
To meet the DSM5 criteria for factitious disorder, the
intentional production or feigning of symptoms must be
evident and no external incentives for the behavior.
 Diagnostic Criteria

Falsification of physical or psychological A

signs or symptoms, or induction of injury
or disease, associated with identified
deception.

Imposed on Self :The individual presents B

himself or herself to others as ill,
impaired, or injured.
Imposed on Another: The individual
presents another individual (victim) to
others as ill, impaired, or C +D
injured.
The deceptive behavior is evident even in the
absence of obvious external rewards. The behavior
is not better explained by another mental disorder,
such as
delusional disorder or another psychotic disorder.
 Etiology
Patients with factitious disorder are more likely to have suffered a major
childhood illness. It appears that for some patients, this early experience with
the healthcare system is pivotal in the development of this disorder. Most
experts agree that patients with factitious disorder are much more likely to
have suffered from a traumatic childhood. There is a strong association among
patients with personality disorders and factitious disorder, and many
overlapping behavioral traits are evident, further supporting the developmental
theory.
 Differential Diagnosis
Deception to avoid legal Malingering
liability Malingering is differentiated from factitious
Caregivers who lie about abuse injuries in
dependents to protect themselves from liability disorder by the intentional reporting of
are not diagnosed with factitious disorder symptoms for personal gain (e.g., money,
imposed on another because protection from time off work). In contrast, the diagnosis of
liability is an external reward. Analysis of factitious
medical records, or interviews, are found to lie disorder requires that the illness falsification
more extensively than needed for immediate is not fully accounted for by external
self-protection are diagnosed with factitious rewards. Factitious disorder and malingering
disorder are not mutually exclusive, however.
imposed on another
Somatic symptom and related Borderline personality
disorders disorder
In somatic symptom disorder and the care- Deliberate physical self-harm in the absence of
seeking type of illness anxiety disorder, there suicidal intent can also occur in association with
may be excessive attention and treatment other mental disorders such as borderline
seeking for perceived medical concerns, but personality disorder.
there is no evidence that the individual is Factitious disorder requires that the induction of
providing false information or injury occur in association with deception.
behaving deceptively
 Differential Diagnosis

Functional neurological symptom disorder

(conversion disorder)
Functional neurological symptom disorder is characterized by neurological
symptoms that are inconsistent with neurological pathophysiology.
Factitious disorder with neurological symptoms is distinguished from
functional neurological symptom disorder by evidence of deceptive
falsification of symptoms

Medical condition or mental disorder not associated with

intentional symptom falsification

Presentation of signs and symptoms of illness that do not conform to an

identifiable medical condition or mental disorder increases the likelihood of the
presence of a factitious disorder. However, the diagnosis of factitious disorder
does not exclude the presence of a true medical condition or mental disorder, as
comorbid illness often occurs in the individual along with factitious disorder
Conclusions
 Reference

● DSM-5 TR
Thanks!