Symptoms

The characteristic feature of somatoform disorders is the sufferer’s need for reassurance from investigations and seeing doctors. Often affected individuals have seen many specialists and have undergone numerous tests and investigations all of the results of which are invariably ‘normal’. As one line of inquiry ends, symptoms often shift to other bodily systems. What is described as the pattern here is typical of ‘somatisation’.

It is important to remember that sufferers have no insight into the psychological nature of their symptoms and are not deliberately feigning symptoms.

Someone who visits their doctor very often for help each time some minor ailment occurs and worries it may be something very serious, such as a stroke, or cancer, and isn’t reassured easily without tests is the typical picture of hypochondriacal disorder. Once again, the sufferer lacks insight into the psychological aspects of the disorder. No serious disorder is ever the cause of the symptoms. The condition can be as worrying for the doctor as the patient!

A rare offshoot of hypochondriasis is when the gain for the patient is not eradication of the symptom but the reassurance that comes from seeing a doctor. This is known as ‘factitious disorder’ and is very uncommon.

Malingering is when someone presents to a doctor or a hospital with symptoms that they deliberately feign for either ‘reward’ that is positive, such as medication (like morphine) or concern; or negative, to avoid some consequence, such as being charged for an offence. The person concerned always knows that what they are doing is simulation. Fortunately, this is extremely rare to see in practice. It may be described as Munchausen’s syndrome.

When an adult deliberately injures a child and then takes them to see a doctor pretending that they don’t know how the child was hurt, simply for the same type of ‘reward’ of medical concern; this is known as Munchausen’s by proxy (the proxy is the child).