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Psychiatry · USMLE Step 1

USMLE Psychiatry: Somatic Symptom and Factitious Disorders

Somatic symptom disorder, illness anxiety disorder, factitious disorder, and malingering distinctions tested on USMLE Step 1.

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What is the core feature of somatic symptom disorder (SSD)?
One or more distressing somatic symptoms plus excessive thoughts, feelings, or behaviors related to those symptoms
How long must symptoms persist for a diagnosis of somatic symptom disorder?
More than 6 months, though a specific symptom need not be continuously present
True or False: somatic symptoms in SSD must be medically unexplained.
False, SSD symptoms can be medically explained or unexplained
What is illness anxiety disorder characterized by?
Preoccupation with having or acquiring a serious illness despite minimal or no somatic symptoms
How long must the preoccupation last for a diagnosis of illness anxiety disorder?
At least 6 months
What is the care-seeking subtype of illness anxiety disorder?
Patients frequently seek medical care, including doctor visits and testing
What is the care-avoidant subtype of illness anxiety disorder?
Patients rarely seek medical care because doing so provokes anxiety
What is conversion disorder (functional neurological symptom disorder)?
A disorder with one or more symptoms of altered voluntary motor or sensory function incompatible with recognized neurological disease
In conversion disorder, patients may show ____, an unexpectedly calm attitude toward their neurological symptoms.
la belle indifference
What commonly precedes the onset of conversion disorder symptoms?
A psychological stressor or conflict
Are conversion disorder symptoms produced consciously or unconsciously?
Unconsciously, the patient does not intentionally produce them
What is primary gain in conversion disorder?
Relief from an internal psychological conflict achieved through the symptom
What is secondary gain?
An external benefit obtained from being sick, such as attention or avoiding responsibilities
What is factitious disorder?
Intentional falsification or induction of physical or psychological symptoms in oneself or another, without obvious external reward
What is the underlying motivation in factitious disorder?
An unconscious psychological need to assume the sick role

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