Match each clinical vignette with the most appropriate psychiatric diagnosis from the somatic symptom and related disorders spectrum.
- A 28-year-old female medical resident is admitted for profound hypoglycemia (glucose 32 mg/dL). Labs show elevated insulin and low C-peptide. She denies medication use, tearfully demands a pancreatectomy for 'suspected insulinoma,' and has no external incentives.Factitious disorder imposed on self
- A 45-year-old man involved in litigation following a minor car accident claims severe neck pain and cognitive disability. On formal neuropsychological testing, his performance is markedly worse than patients with severe brain injuries, showing inconsistent effort.Malingering
- A 42-year-old man with occasional, mild caffeine-induced muscle twitches visits the clinic weekly, terrified he has Huntington disease. He spends hours daily researching the disease and checking his gait, despite consistently normal neurological exams.Illness anxiety disorder
- A 38-year-old woman with a 3-year history of non-cardiac chest pain and fatigue has had multiple negative cardiac catheterizations. She states the pain is constantly on her mind and quit her job to rest, fearing an imminent heart attack.Somatic symptom disorder
- A 25-year-old man develops sudden-onset right arm weakness after a marital argument. Examination reveals weakness during active elbow flexion but simultaneous palpable contraction of the triceps. He exhibits 'la belle indifférence' toward his deficit.Functional neurological symptom disorder
Answer
Vignette 1 maps to Factitious disorder; Vignette 2 to Malingering; Vignette 3 to Illness anxiety disorder; Vignette 4 to Somatic symptom disorder; Vignette 5 to Functional neurological symptom disorder.
Each vignette provides pathognomonic clues to differentiate the psychiatric diagnoses. Intentional production with no external gain is factitious disorder; intentional production for external gain is malingering. Unconscious production with minimal symptoms but high disease fear is illness anxiety disorder; unconscious production with prominent physical symptoms is somatic symptom disorder; and incompatible neurologic findings indicate conversion disorder.
Step-by-Step Solution
Key Concept
Differentiation of somatic symptom and related disorders based on intent, motivation, and symptom focus.