Match each clinical presentation to the most appropriate psychiatric or behavioral diagnosis on the somatic symptom spectrum.
- A 32-year-old phlebotomist is admitted for her third episode of polymicrobial bacteremia this year. Blood cultures grow both skin and enteric flora. She has a central venous catheter, and nurses note her dressing is frequently tampered with. Despite the severe infections, she is remarkably cooperative, pleasant, and eager for further invasive procedures.Factitious disorder
- A 26-year-old man develops sudden-onset bilateral lower extremity paralysis immediately following a traumatic divorce proceeding. Neurological examination reveals intact deep tendon reflexes, normal muscle bulk, and a positive Hoover sign. He appears surprisingly unconcerned about his sudden inability to walk.Conversion disorder (functional neurological symptom disorder)
- A 45-year-old executive visits various specialists weekly, convinced he has early-onset Alzheimer disease because he occasionally forgets minor details. He has no other cognitive or physical symptoms, but spends hours nightly researching dementia online, remaining highly anxious despite multiple normal comprehensive neurological and neuropsychological evaluations.Illness anxiety disorder
- A 42-year-old warehouse worker presents with complaints of debilitating, diffuse back pain after a minor slip at work six months ago. He exhibits marked pain behaviors in the clinic, refuses physical therapy, and demands permanent disability documentation. However, independent surveillance video shows him effortlessly lifting heavy boxes into his truck.Malingering
- A 50-year-old woman has a 10-year history of chronic pelvic pain, migrating polyarthralgias, and diffuse abdominal discomfort. She has undergone three negative laparoscopies and countless imaging studies. She constantly worries about the severity of her symptoms, and her perceived medical frailty has led her to quit her job and isolate herself at home.Somatic symptom disorder
Answer
The correct matches differentiate the psychiatric conditions based on intentionality of symptom production, underlying motivation (internal vs. external), and the presence versus absence of prominent somatic symptoms.
Each clinical vignette provides pathognomonic features for a distinct condition on the somatic symptom spectrum. Proper classification relies on identifying symptom intentionality, motivating factors, and symptom severity.
Step-by-Step Solution
Key Concept
Differential diagnosis of somatic symptom and related disorders requires evaluating three core dimensions: 1) Are the symptoms intentionally produced? 2) Is the motivation internal (sick role) or external (secondary gain)? 3) Are prominent physical symptoms present, or is the distress purely driven by disease-related anxiety?