Deck 5: Somatic Symptom, Dissociative, and Factitious Disorders

Question 1

Heather complains of weakness in the left side of her body, nausea, difficulty walking, and severe headaches. Although she has had a complete medical work-up, no physiological basis for her complaints has been found. Despite this medical clearance, she does not feel well enough to return to college studies. Which of the following best describes Heather's symptoms?

A) Factitious disorder
B) Somatic symptom disorder
C) Dissociative disorder
D) Depersonalization disorder

Answer 1

Somatic symptom disorder

Question 2

Which of the following symptoms could lead to abnormal eating patterns or food avoidance?

A) Aphonia
B) Globus
C) La belle indifference
D) Glove anesthesia

Answer 2

Globus

Question 3

Derrick has experienced intense pain in his lower back for the last 18 months. Even though an extensive medical evaluation found no physical basis for his complaints, he feels in too much pain to return to work. Derrick is becoming angry and depressed over his doctor's view that his problem is in his head and often spends time visiting emergency rooms for pain medication. Given what you know, what may Derrick be experiencing?

A) Conversion disorder
B) Somatic symptom disorder
C) Hypochondriasis
D) Body dysmorphic disorder

Answer 3

Somatic symptom disorder

Question 4

Which of the following is a somatic symptom and related disorder?

A) Pain disorder
B) depersonalization disorder
C) Somatic symptom dissociative amnesia
D) Factitious disorder

Question 5

The most common symptom group in conversion disorder is

A) sensory defecits.
B) globus.
C) psychogenic convulsions.
D) motor symptoms or deficits.

Question 6

Glove anesthesia involves

A) wearing gloves to avoid paralysis.
B) complication of the neurological system.
C) loss of sensitivity in the hand and wrist.
D) sensation of extreme pain in the hand.

Question 7

Among all the symptoms found in somatic symptom disorder, pseudoseizures are

A) less common.
B) more common.
C) seen as frequently as pain complaints.
D) excluded from the category.

Question 8

Select the statement that is True of "la belle indifference" in conversion disorders.

A) It is a key symptom in its diagnosis.
B) It is not seen in teens with the disorder.
C) It causes significant psychological distress.
D) Some people with conversion disorder do not exhibit it.

Question 9

Mrs. Borhoquez is terrified that she has contracted a viral infection that is invading her body and weakening her immune system. In spite of medical tests that show no illness, she continues to surf the Internet looking for a diagnostic match to her symptoms. Family members were sympathetic at first but now are tired of hearing the same old complaints. Mrs. Borhoquez presents a classic case of

A) illness anxiety disorder.
B) pain disorder.
C) conversion disorder.
D) psychosomatic disorder.

Question 10

Somatic symptom disorders were originally known as

A) stress-related disorders.
B) psychosocial disorders.
C) psychophysiological disorders.
D) hysteria.

Question 11

What do all types of somatic symptom and related disorders have in common?

A) Awareness that the symptoms are psychological
B) Lack of personal distress
C) Lack of a recognizable medical cause
D) Deception by the "ill" person

Question 12

Altered sensory and motor experiences are characteristic of _____ disorder.

A) somatic symptom
B) conversion
C) illness anxiety
D) factitious

Question 13

Linda was driving to work when she suddenly experienced a narrowing of her visual field. Pulling off to the side of the road, she suddenly lost her vision. After undergoing extensive medical testing, her physical condition was attributed to psychological factors. What diagnosis might Linda be given?

A) Conversion disorder
B) Undifferentiated somatic symptom disorder
C) Somatic symptom disorder
D) Hypochondriasis

Question 14

As in the case of Anna O., the term "conversion disorder" implies a conversion of

A) physical symptoms into neurological problems.
B) psychological stress into real organic problems.
C) psychological stress into physical symptoms.
D) one psychological problem into another.

Question 15

About _____% of the people diagnosed with conversion disorder are later found to have a diagnosable medical condition.

A) 1-5
B) 5-10
C) 10-15
D) 15-20

Question 16

Conversion disorders and neurological problems may be discriminated from each other on the basis of

A) neurological patterns.
B) patient complaints.
C) duration of symptoms.
D) severity of symptoms.

Question 17

Approximately 85% to 95% of the general population experiences at least one physical symptom every

A) day.
B) week.
C) 2-4 weeks.
D) 2-3 months.

Question 18

Among all the symptoms of somatic symptom disorders, _______ is among the most frequently reported.

A) pain
B) heart palpitations
C) limb weakness
D) food intolerance

Question 19

Under what condition would a person be diagnosed with somatic symptom disorder?

A) When the symptoms are due to a single physical condition
B) When the condition first presents itself after an episode of heavy drinking
C) When the symptoms are long-standing
D) When the impairment occurs after use of a prescription drug

Question 20

In 1859, ________ wrote a paper describing psychiatric patients whose disorders appeared to lack medical causes for their distress.

A) Pierre Briquet
B) Philippe Pinel
C) Sigmund Freud
D) Josef Breuer

Question 21

According to your text, patients with medically unexplained symptoms make up _____% of all primary-care physicians' appointments.

A) 5-10
B) 10-20
C) 15-30
D) 25-35

Question 22

Which of the following would be associated with factitious disorder?

A) A woman suffering from severe abdominal pains that have no medical basis.
B) A man feigning illness to get out of criminal prosecution.
C) In order to get money during a lawsuit, a man says he is experiencing great pain in his back with no medical corroboration.
D) A woman holds a thermometer up to a hot surface to create a high temperature reading and then uses it as "evidence" that she has a fever.

Question 23

Which of the following is the most common somatic symptom in adults?

A) voluntary motor dysfunction
B) sensory dysfunction
C) pseudoseizures
D) dysfunctional heart

Question 24

On average, how many fewer days per month do people with somatic symptom disorders work compared to those who do not have a somatic symptom disorder?

A) 3.3
B) 5.6
C) 7.8
D) 9.2

Question 25

According to the Research Hot Topic presentation in your text, chronic fatigue syndrome

A) is the result of the Ross River Virus.
B) is the result of an immune deficiency.
C) may be the result of multiple factors.
D) may be the result of a brain dysfunction.

Question 26

From the psychoanalytic perspective, somatic symptom disorders may be understood as resulting from

A) the failure of ego defense mechanisms to shield the person from anxiety.
B) a conversion of psychological conflicts into physical symptoms.
C) a fixation at an early developmental stage resulting in failure to resolve conflicts.
D) a regression to an earlier stage of development when the person felt secure.

Question 27

Even though approximately 20% of the general population report physical symptoms with no organic basis, many

A) do not seek medical treatment.
B) do not meet DSM criteria for a somatic symptom disorder.
C) doctor-shop but do not choose to have surgery.
D) know that their symptoms have psychological origins.

Question 28

There are two types of factitious disorder. The first is imposed on the self. The other is:

A) malingering
B) psychogenic seizure
C) imposed on another
D) globus

Question 29

People with factitious disorder often:

A) self-loathe
B) have personality disorders
C) panic attacks
D) self-injure

Question 30

"Doctor, I know I have a terrible disease and you just aren't telling me. I do not believe you when you say everything checked out okay." Which DSM-5 diagnosis might be typical for someone making those comments?

A) Factitious disorder
B) Hypochondriasis
C) Illness anxiety disorder
D) Somatic symptom disorder

Question 31

Overall, the course of recovery, remission, and chronicity in the somatic symptom disorders is

A) complex.
B) highly predictable.
C) similar across diagnoses.
D) different for men and women.

Question 32

A mother brings her child into the hospital emergency room repeatedly for various illnesses that include breathing problems, diarrhea, and seizures. The doctors could not find anything wrong with the child and determined that the symptoms were actually induced by the mother. What would this disorder be called?

A) factitious disorder imposed on self
B) factitious disorder imposed on another
C) dissociative disorder
D) malingering

Question 33

After contracting an actual acute illness, some individuals exhibit signs of which of the following, as they fear they are not over the illness or worry that they need to limit activities?

A) la belle indifference
B) body dysmorphic disorder
C) factitious disorder
D) transient hypochondriasis

Question 34

At this time, the etiology of somatic symptom disorders is poorly understood and usually approached from a ________ perspective.

A) physiological
B) psychological
C) medical
D) interpersonal

Question 35

Which theoretical construct provided the bases for the name "conversion disorder"?

A) humanistic
B) behavioural
C) psychodynamic
D) existential

Question 36

Which of the following would be the diagnosis if an individual intentionally fabricated physical or psychological illness?

A) hypochondriasis
B) body dysmorphic disorder
C) factitious disorder
D) conversion disorder

Question 37

People with somatic symptom disorders often have comorbid anxiety or

A) dissociative disorders.
B) personality disorders.
C) depressive disorders.
D) bipolar disorders.

Question 38

Although rare before adulthood, somatic symptom disorders

A) are very prevalent in old age.
B) are evaluated in children using different DSM criteria.
C) are found to be more severe among adolescents and children.
D) have the same diagnostic criteria in children, adolescents, and adults.

Question 39

Which of the following is True of illness anxiety disorder?

A) It is rarely found in Eastern cultures.
B) It rarely occurs in men.
C) It is often comorbid with anxiety and depressive disorders.
D) It always follows diagnosis of an actual medical problem.

Question 40

What percentage of individuals with illness anxiety disorder are diagnosed with this disorder alone?

A) 10
B) 12
C) 18
D) 23

Question 41

Which of the following risk factors is most strongly associated with somatic symptom disorders in children?

A) stress
B) family violence and conflict
C) history of sexual abuse
D) family separation and loss

Question 42

What percentage of Canadian psychiatrists believe that there is strong scientific evidence to support a dissociative disorder diagnosis:

A) 12%
B) 25%
C) 47%
D) 14%

Question 43

Relaxation training, distracting attention, and correcting automatic thoughts are elements of the _____ treatment of somatic symptom disorders?

A) biomedical
B) psychodynamic
C) integrative
D) cognitive-behavioural

Question 44

Margo described upsetting experiences as "being out-of-body" and as being an observer of her own behaviour. Which type of dissociative experience was she undergoing?

A) Depersonalization
B) Derealization
C) Amnesia
D) Identity alteration

Question 45

The widely varying rates of dissociative disorders found throughout the world may point to their being a

A) culture-free syndrome.
B) culture-bound syndrome.
C) prevalent disorder independent of culture.
D) universal psychological phenomenon.

Question 46

The notion that sufferers of somatic symptom disorders may experience bodily sensations as intense, noxious, and disturbing is known as

A) somatic over-sensitivity.
B) somatic amplification.
C) somatic desensitization.
D) somatic delusions.

Question 47

Empirical trials that have investigated dissociative identity disorder suggest that between 10 and 21% of patient's have

A) symptoms of temporal lobe epilepsy.
B) structural brain damage.
C) evidence of brain tumors.
D) abnormal brain activity.

Question 48

Children as young as 8 years of age have been diagnosed with dissociative identity disorder; however, these children

A) were also diagnosed as having schizophrenia.
B) also had comorbid psychological diagnoses.
C) are really too young to understand the concept of identity.
D) did not reveal the presence of alters.

Question 49

The diagnosis of dissociative identity disorder may depend on the

A) beliefs of the diagnostician.
B) presence of more than three alters.
C) sex of the patient.
D) patient's ability to identify alters before the therapeutic visit.

Question 50

Which of the following accounts for the largest outpatient medical costs?

A) somatization and psychiatric disorder
B) no somatization, no psychiatric disorder
C) somatization only
D) psychiatric disorder only

Question 51

A few weeks ago, Marne experienced a sudden feeling of being removed from her body and observing herself sitting in class taking notes. This unusual experience has recurred. Yesterday, she had a sense that the hand that was writing notes was not her hand; she felt no pressure of the pencil against her fingers. Which of the following is most likely Marne's diagnosis?

A) Depersonalization disorder
B) Dissociative identity disorder
C) Dissociative fugue
D) Dissociative amnesia

Question 52

Aisha's mother tends to hover over her whenever she complains of not feeling well. Typically, she puts Aisha to bed, reads her a story, and spends the day bringing the child her favorite foods. From a behavioural perspective, Aisha's mother may be increasing the child's risk of developing a somatic symptom disorder because she is

A) negatively reinforcing complaints about physical health.
B) classically conditioning avoidance behaviour.
C) punishing appropriate physical health complaints.
D) reinforcing somatizing behaviours.

Question 53

Dissociative amnesia involving recall of factual information may be _____ or generalized.

A) iatrogenic
B) specific
C) localized
D) dispersed

Question 54

Tad is being treated for factitious disorder and is currently undergoing relaxation training. He is most likely being seen by a therapist with which of the following orientations?

A) Psychoanalytic
B) Rational-emotive
C) Cognitive-behavioural
D) Psychiatric

Question 55

Which of the following has contributed to the questionable scientific status of the category dissociative identity disorder?

A) Low prevalence rates of the disorder
B) The violent nature of persons with the disorder
C) Its restriction to the American culture
D) The lack of empirical quantitative investigations

Question 56

According to the _____model, somatic symptom disorders reflect a complex interplay between physical and psychological factors.

A) behavioural
B) cognitive
C) integrative
D) psychodynamic

Question 57

A young man was picked up by police after he was found wandering along the Trans-Canada Highway in a confused state. The man possessed no identifying information and he was unable to say who he was or where he lived. After his photograph appeared on television, a woman from an adjoining Province identified the man as her father. What form of dissociative disorder did this man appear to have?

A) Dissociative identity disorder
B) Dissociative fugue
C) Dissociative amnesia
D) Depersonalization disorder

Question 58

Which of the following accounts for the lowest inpatient medical costs?

A) no somatization, no psychiatric disorder
B) somatization and psychiatric disorder
C) somatization only
D) psychiatric disorder only

Question 59

"So many men get prostate cancer, it must be some type of unidentified bacterial infection." This inaccurate belief about illness supports a _____________ theory of somatic symptom disorders.

A) behavioural
B) sociomedical
C) psychoneurological
D) cognitive

Question 60

Which of the following statements regarding dissociative experiences is False?

A) Any dissociative experience is considered evidence of a dissociative disorder.
B) As many as 74% of the normal population experience occasional episodes of derealization.
C) Dissociative experiences are also reported in persons with other psychological disorders.
D) Experiences of dissociation may be temporary and transient or chronic conditions.

Question 61

What conclusions may be drawn from the research on recovered/False memories?

A) Just because someone is able to provide a detailed memory of an event and is confident that it is accurate, the remembered event may not actually have happened.
B) Memories of childhood trauma that are recovered after a person enters therapy tend to be more reliable than memories recovered before therapy.
C) Research has demonstrated that recovered memories tend to occur after a client is in therapy and a therapist suggests the presence of early sexual trauma.
D) Although there is limited research evidence, most cases of dissociative identity disorder have been associated with repressed memories of sexual abuse trauma.

Question 62

Laboratory results for patients with factitious disorders have revealed

A) patients purposely placing blood in their urine sample.
B) patients with high bacteria counts after accidental exposure to infectious diseases
C) patients requesting labwork with no signs of health problems.
D) patients minimizing or hiding body infections.

Question 63

Factitious disorder was originally termed ________ after a baron who told tall tales.

A) Tall tale syndrome
B) Proxy syndrome
C) Faker's syndrome
D) Munchausen syndrome

Question 64

Cognitive-behavioural therapy approaches the treatment of dissociative disorders by assuming that

A) people misinterpret physiological cues.
B) people create symptoms through denial.
C) many people have talked themselves into being sick.
D) few, if any, patients have True symptoms of dissociation.

Question 65

Approximately, 6 to 22 percent of child victims of factitious disorder die as a result of medical illnesses

A) that are over-medicated.
B) for which the child is not hospitalized.
C) while hospitalized.
D) inflicted upon them by a caregiver.

Question 66

Although data from controlled trials are not available, it appears that factitious disorder is a chronic condition that

A) begins in early childhood.
B) is limited to children and adolescents.
C) results in impairment of social and occupational functioning.
D) is limited to the American culture.

Question 67

Factitious disorders differ from somatic symptom and dissociative disorders in that the former

A) are prevalent in childhood and early adolescence.
B) have real physical bases and may be life-threatening.
C) are intentionally produced to assume a sick role.
D) remit once the patient is reassured about good health.

Question 68

The department of social work at a local hospital has been contacted regarding an unusual case. A 2-year-old child is brought to the hospital 3 times over a two-week period for "breathing problems." Each time the symptoms are present, the mother is with the child. At the third visit, the child is hospitalized, and during the course of an over-night stay, the child appears normal. However, by mid-morning after the mother has returned to the hospital, the breathing monitor sounds an alarm. What concern might the medical staff have regarding this case?

A) Factitious disorder imposed on another
B) Factitious disorder
C) Somatic symptom disorder
D) Iatrogenic disorder

Question 69

A disorder that is inadvertently caused by a physician, medical or surgical treatment, or a diagnostic procedure is known as a(n) ________ response.

A) unconscious
B) iatrogenic
C) factitious
D) dissociative

Question 70

According to proponents of dissociative identity disorder, a failure of _______ may cause the onset of the illness.

A) the normal process of "personality integration"
B) normal attachment processes
C) executive brain function
D) developmental task mastery

Question 71

Jill was the victim of a fender-bender accident in which she was driving a car struck in a parking lot. Although she felt well initially, she developed back pain after being contacted by the other driver's insurance company. A thorough review of her medical complaints by her physician found no signs of an actual medical disorder. Nevertheless, Jill maintains that she has severe back pain that limits all of her activities except attending college classes. Given this case scenario, what condition might Jill be presenting?

A) Somatic symptom disorder
B) Malingering
C) Factitious disorder
D) Factitious disorder by proxy

Question 72

Clinical reports reveal that antidepressants may be effective in the treatment of derealization and dissociative identity disorder. However,

A) to be effective, the medications must be administered at the onset of the disorder.
B) suicidal risk increases with the length of treatment and the degree to which the patient experiences improvement in symptoms.
C) it is unclear whether the medication works on core symptoms or associated anxiety and depression.
D) clinical trials reveal that the percentage of patients helped through medication is less than 15%.

Question 73

Select the statement that is True of the relationship between severe childhood trauma and dissociative identity disorder.

A) Longitudinal data support the relationship.
B) Data supporting the relationship are correlational.
C) Patients with early trauma histories usually develop the disorder.
D) Epidemiological data support the relationship.

Question 74

Mitchell was walking near campus late in the evening when he was assaulted and robbed at gunpoint. When questioned by police, he was unable to provide a description of his attacker. Experimental data suggest this demonstrates that under conditions of high arousal,

A) people have amnesia for faces.
B) people try to forget disturbing scenes.
C) people pay attention to the central feature of an event.
D) people don't remember some details because they are not obvious.

Question 75

Both dissociative amnesia and dissociative fugue

A) require treatment by medication and psychotherapy.
B) are best treated using antidepressants.
C) require lengthy therapeutic treatment.
D) involve loss of memory.

Question 76

Which of the following is False regarding memory?

A) According to research, memory appears to be more of a passive process than an active one.
B) Research on human memory tells us that memory involves reconstruction of events.
C) Memories recalled in detail and with confidence may not always be valid recollections.
D) Asking misleading questions leads eye witnesses to construct memories for events that did not happen.

Question 77

One way to discriminate between factitious disorder and malingering would be to look for ______________________ in malingering patients.

A) somatic symptoms
B) a parent with a need for attention
C) hypochondriacal tendencies
D) associated external incentives

Question 78

A teenage girl was brought to the emergency room by her mother several times during the summer for severe abdominal pain. After many diagnostic tests returned negative results, the girl was hospitalized for observation. Over several days, the patient's abdominal pain disappeared. However, the night before her discharge, the pain returned. A hospital security camera recorded the mother entering her child's room late that night carrying a bag from the neighborhood pharmacy. Shortly after this visit the girl's symptoms returned. The hospital staff might suspect that

A) the mother is suffering from factitious disorder imposed on self.
B) this is a case of factitious disorder imposed on another.
C) the teenager is malingering.
D) the mother is malingering.

Question 79

Among persons with factitious disorder imposed on another, ____ to _____ percent are women.

A) 90; 100
B) 29; 45
C) 77; 98
D) 10; 25

Question 80

From a psychoanalytic perspective, factitious disorders may be viewed as a form of ______, while behaviourists would view it as being maintained through _________.

A) masochism; positive reinforcement
B) masochism; extinction
C) sadism; positive reinforcement
D) sadism; extinction