🔑 Key Learning

  • Medically unexplained physical symptoms may reflect somatisation, anxiety, dissociation, or conscious feigning
  • Somatisation disorder involves multiple vague symptoms with refusal to accept reassurance
  • HypoChondriasis centres on a fear of a specific condition (e.g. cancer), despite negative results
  • Conversion disorder presents with neurological (e.g. weakness) deficits but no physical cause, often with emotional indifference (la belle indifference) 
  • Factitious disorder and malingering both involve intentional feigning, but differ by motivation
  • Dissociative disorders typically follow trauma and include amnesia, depersonalisation, or identity disturbance

🤕 Somatisation Disorder

  • Multiple vague physical symptoms over time
  • Persistent demand for medical investigations despite negative findings
  • Patient resists reassurance or psychological explanations

Tip: Somatisation = Symptoms

😟 Hypochondriasis (Illness Anxiety Disorder)

  • Persistent belief of having a serious illness (e.g. cancer), despite negative investigations
  • High anxiety about health
  • Disbelief in medical reassurance or test results

Tip: Hypochondriasis = Condition or Cancer

🧠 Conversion Disorder (Functional Neurological Symptom Disorder)

  • Loss of motor or sensory function (e.g. paralysis, blindness, aphonia)
  • No medical explanation found
  • Symptoms are not consciously faked
  • May present with la belle indifférence (lack of concern about serious symptoms)

🪞 Dissociative Disorders

  • Typically arise in response to trauma or stress
  • Key features:
    • Depersonalisation – feeling detached from self
    • Derealisation – feeling that the world is unreal
    • Dissociative amnesia – inability to recall important personal information
    • Dissociative Identity Disorder (DID) – presence of two or more distinct identities

Symptoms can last from hours to months and may fluctuate

🎭 Factitious Disorder (Munchausen’s Syndrome)

  • Intentional production of physical or psychological symptoms
  • No obvious external gain — motivation is to adopt the ‘sick role’
  • Often dramatic presentations and willingness to undergo invasive procedures

💼 Malingering

  • Intentional feigning of symptoms
  • Motivation is external:
    • Financial compensation
    • Avoiding work
    • Gaining drugs (opioids, gabapentinoids) or housing

📝 Exam Clues & Clinchers

  • Multiple vague complaints + repeated negative investigations → somatisation disorder
  • Fear of cancer despite repeated normal tests → hypochondriasis
  • Sudden blindness or paralysis + unconcerned + normal MRI → conversion disorder
  • Claims of multiple personalities or amnesia after trauma → dissociative disorder
  • Deliberate symptom production with no reward → factitious disorder (Munchausen's)
  • Fake symptoms + financial or personal benefit → malingering