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Which disorder fits this pattern of unexplained bodily symptoms?
More, if you want it
Does the patient cause the illness on purpose?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: a lasting belief in serious illness despite negative tests.
You can: Tell hypochondriasis from somatisation disorder by a fixed belief in one serious illness.
Definition: lasting tiredness and post-exertional exhaustion after a viral illness.
You can: Name chronic fatigue syndrome when tiredness and exhaustion after effort follow a viral illness.
Definition: unexplained pain or burning with normal tests, often after a stressor.
You can: Tell somatoform pain disorder from somatisation disorder by pain after a stressor.
Definition: many changing physical symptoms over years with normal tests.
You can: Tell somatisation disorder from hypochondriasis by symptoms that change over years.
Definition: the ICD-11 term that replaces somatisation and somatoform disorders.
You can: Name bodily distress disorder when an ICD-11 term is needed for these disorders.
You can: Tell factitious disorder from somatoform pain disorder by whether the patient produces the illness on purpose.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
- : illness that the patient produces on purpose.
Factitious disorder is the deliberate production of illness by the patient.
is the deliberate production of illness by the patient. The patient may do this by ingesting substances, simulating seizures, manipulating tests or falsifying records. The patient often knows symptoms well and shows acceptance of invasive procedures.
Reported examples include swallowing anticoagulants, tampering with a sweat test, and interfering with a pulse oximeter probe. Warning signs include tests that dispute the patient's story and a history of work in healthcare. A factitious patient seeks the sick role. A malingerer seeks a tangible gain, such as money. The faker makes the illness on purpose (factitious disorder), the worrier fears one serious disease (hypochondriasis), and a virus drains the patient (chronic fatigue syndrome). Stress then burning is somatoform pain disorder, wandering symptoms over years are somatisation disorder, and aches everywhere with repeated visits is bodily distress disorder, the newer ICD term.
Daniel is on a neurology ward with repeated fits. Staff find his records altered. He says, "Do the lumbar puncture again, I don't mind."
Candidates see normal tests and call the patient a faker. Vague complaints with no fabrication do not fit factitious disorder. Factitious disorder needs proof that the patient produces the illness.
Mnemonic
Faker fakes, worrier fears, virus drains, stress burns, symptoms wander, aches everywhere. Cue: no sign of fabrication
Analogy
A smoke alarm can ring when there is no fire. Somatoform symptoms are that ringing, sounding while the tests stay normal. Factitious disorder is a person holding a match to the sensor on purpose.
Where the analogy breaks: a real alarm feels nothing, and the patient feels the pain.
Factitious disorder is the deliberate production of illness by the patient.
Hypochondriasis is a persistent conviction of serious illness despite negative investigations.
is a persistent conviction of serious illness despite negative investigations. Reassurance brings only temporary relief. The patient keeps seeking help, often angry or dissatisfied.
Some patients have worried about bodily health since adolescence or earlier. These concerns can be part of their personality. Doctors may prolong health anxiety by giving unclear information that misses the patient's own fears.
Priya attends a cardiology clinic yet again. Her ECGs are normal. She says, "I know I have heart disease, and nobody listens."
looks like hypochondriasis at first. In somatisation disorder the complaint is the symptoms themselves. Hypochondriasis centres on fear of one serious disease.
Hypochondriasis is a persistent conviction of serious illness despite negative investigations.
Chronic fatigue syndrome (ME/CFS) is lasting tiredness after a viral illness with normal investigations.
Chronic fatigue syndrome (ME/CFS) is lasting tiredness after a viral illness with normal investigations. Patients report unrefreshing sleep, muscle soreness and , which is exhaustion after effort.
Tom is a student seen in a GP surgery. His blood tests are normal. He says, "Since that virus, one walk wipes me out for days."
Candidates code tiredness after a virus as . ICD-10 codes ME/CFS as . ICD-10 does not code ME/CFS as neurasthenia.
Chronic fatigue syndrome (ME/CFS) is lasting tiredness after a viral illness with normal investigations.
Somatoform pain disorder is persistent unexplained pain or burning sensations with normal examination and investigations.
is persistent unexplained pain or burning sensations with normal examination and investigations. The pain often follows a .
Pain is common in depression, anxiety, panic and somatoform disorders. Patients with several pains are more likely to have a linked psychiatric disorder. Doctors can prolong the problem by giving unclear information that ignores the patient's fears. The patient does not choose the symptoms.
Beverley attends the unexplained symptoms clinic at Leeds General Infirmary. Her tests are normal. She says, "My feet have burned since I lost my job."
Somatisation disorder also has normal tests. Somatisation disorder brings many symptoms that change over years. Somatoform pain disorder is one lasting pain after a stressor.
Somatoform pain disorder is persistent unexplained pain or burning sensations with normal examination and investigations.
Somatisation disorder is multiple, recurrent, changing physical symptoms over years with normal investigations.
Somatisation disorder is multiple, recurrent, changing physical symptoms over years with normal investigations. The patient often makes a request for operations. The patient feels the symptoms.
One reported case had a fixed belief in an intestinal obstruction. An exploratory operation followed, then repeated operations. No specific pathology was found.
Maria sees a surgeon about stomach pain. Last year she had back pain and dizziness. She says, "Please just operate and find the cause."
Candidates call the many requests health anxiety. A patient with hypochondriasis fears one named disease. Symptoms that change over years with operation requests mean somatisation disorder.
Somatisation disorder is multiple, recurrent, changing physical symptoms over years with normal investigations.
Bodily distress disorder is the ICD-11 term that replaces somatisation and somatoform disorders.
Bodily distress disorder is the ICD-11 term that replaces somatisation and somatoform disorders. Vague, generalised bodily symptoms bring repeated attendance despite reassurance.
In primary care, many patients with psychiatric disorder present with physical symptoms. These patients were once called somatizers.
Kwame sees his GP every week about aches all over. His tests are normal. He says, "I still feel unwell, whatever you tell me."
Candidates use the older names when asked for the newer term. ICD-11 groups somatisation and somatoform disorders as bodily distress disorder.
Bodily distress disorder is the ICD-11 term that replaces somatisation and somatoform disorders.
Only factitious disorder involves deliberate production of illness.
| Term | Patient says | Often mistaken for | Deciding feature |
|---|---|---|---|
| Factitious disorder | "Do the test again" | Somatoform pain disorder | Illness produced on purpose |
| Hypochondriasis | "I know I have heart disease" | Somatisation disorder | Fixed belief in serious illness |
| Chronic fatigue syndrome | "One walk wipes me out" | Neurasthenia | Exhaustion after a viral illness |
| Somatoform pain disorder | "My feet burn" | Factitious disorder | Pain after a stressor |
| Somatisation disorder | "Please operate" | Hypochondriasis | Changing symptoms over years |
| Bodily distress disorder | "I still feel unwell" | Hypochondriasis | ICD-11 term for vague symptoms |
Only factitious disorder involves deliberate production of illness. In the other disorders, the patient feels the symptoms.
Only factitious disorder involves deliberate production of illness.
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