Somatoform Disorders in DSM-IV are referred to as Somatic Symptom and Related

Disorders in DSM-5. Which of the following features characterizes the

major diagnosis in this class, somatic symptom disorder?
A. Medically unexplained somatic symptoms.
B. Underlying psychic conflict.
C. Masochism.
D. Distressing somatic symptoms and abnormal thoughts, feelings, and behaviors
in response to these symptoms.
E. Comorbidity with anxiety and depressive disorders.
9.2 In DSM-IV, a patient with a high level of anxiety about having a disease and
many associated somatic symptoms would have been given the diagnosis of
hypochondriasis. What DSM-5 diagnosis would apply to this patient?
A. Hypochondriasis.
B. Illness anxiety disorder.
C. Somatic symptom disorder.
D. Generalized anxiety disorder.
E. Unspecified somatic symptom and related disorder.
9.3 In DSM-III and DSM-IV, a large number of somatic symptoms were needed to
qualify for the diagnosis of somatization disorder. How many somatic symptoms
are needed to meet symptom criteria for the DSM-5 diagnosis of somatic
symptom disorder?
A. Four: at least one pseudoneurological, one pain, one sexual, and one gastrointestinal
symptom.
B. Fifteen, distributed across several organ systems.
C. One.
D. At least one that is medically unexplained.
E. None.
After an airplane flight, a 60-year-old woman with a history of chronic anxiety
develops deep vein thrombophlebitis and a subsequent pulmonary embolism.
Over the next year, she focuses relentlessly on sensations of pleuritic chest pain
and repeatedly seeks medical attention for this symptom, which she worries is
due to recurrent pulmonary emboli, despite negative test results. Review of
systems reveals that she also has chronic back pain and that she has consulted
many physicians for symptoms of culture-negative cystitis. What diagnosis
best fits this clinical picture?
A. Post–pulmonary embolism syndrome.
B. Chest pain syndrome.
C. Hypochondriasis.
D. Pain disorder.
E. Somatic symptom disorder.
9.5 Which of the following is a descriptive specifier included in the diagnostic criteria
for somatic symptom disorder?
A. With predominant pain.
B. With hypochondriasis.
C. With psychological comorbidity.
D. Psychotic type.
E. Undifferentiated.
9.6 A 60-year-old man has prostate cancer with bony metastases that cause persistent
pain. He is treated with antiandrogen medications that result in hot
flashes. He is unable to work because of his symptoms, but he is stoical, hopeful,
and not anxious. What is the appropriate diagnosis?
A. Pain disorder.
B. Illness anxiety disorder.
C. Somatic symptom disorder.
D. Psychological factors affecting other medical conditions.
E. No diagnosis.
9.7 Illness anxiety disorder involves a preoccupation with having or acquiring a
serious illness. How severe must the accompanying somatic symptoms be to
meet criteria for the diagnosis of illness anxiety disorder?
A. Mild to moderate severity.
B. Moderate to high severity.
C. Any level of severity.
D. Mild severity at most, but there need not be any somatic symptoms.
E. None of the above; the presence of any somatic symptoms rules out the diagnosis
of illness anxiety disorder.
9.8 Over a period of several years, a 50-year-old woman visits her dermatologist’s
office every few weeks to be evaluated for skin cancer, showing the dermatologist
various freckles, nevi, and patches of dry skin about which she has become
concerned. None of the skin findings have ever been abnormal, and the
dermatologist has repeatedly reassured her. The woman does not have pain,
itching, bleeding, or other somatic symptoms. She does have a history of occasional
panic attacks. What is the most likely diagnosis?
A. Unspecified anxiety disorder.
B. Illness anxiety disorder.
C. Hypochondriasis.
D. Somatic symptom disorder.
E. Factitious disorder.
9.9 A 45-year-old man with a family history of early-onset coronary artery disease
avoids climbing stairs, eschews exercise, and abstains from sexual activity for
fear of provoking a heart attack. He frequently checks his pulse, reads extensively
about preventive cardiology, and tries many health food supplements
alleged to be good for the heart. When he experiences an occasional twinge of
chest discomfort, he rests in bed for 24 hours; however, he does not go to doctors
because he fears hearing bad news about his heart from them. What diagnosis
best fits this clinical picture?
A. Persistent complex bereavement disorder.
B. Adjustment disorder.
C. Illness anxiety disorder.
D. Unspecified somatic symptom and related disorder.
E. Somatic symptom disorder.
9.10 A 25-year-old woman is hospitalized for evaluation of episodes in which she
appears to lose consciousness, rocks her head from side to side, and moves her
arms and legs in a nonsynchronous, bicycling pattern. The episodes occur a
few times per day and last for 2–5 minutes. Electroencephalography during the
episodes does not reveal any ictal activity. Immediately after a fit, her sensorium
appears clear. What is the most likely diagnosis?
A. Epilepsy.
B. Malingering.
C. Somatic symptom disorder.
D. Conversion disorder (functional neurological symptom disorder), with attacks
or seizures.
E. Factitious disorder.
9.11 Which of the following symptoms is incompatible with a diagnosis of conversion
disorder (functional neurological symptom disorder)?
A. Light-headedness upon standing up.
B. Dystonic movements.
C. Tunnel vision.
D. Touch and temperature anesthesia with intact pinprick sensation over the
left forearm.
E. Transient leg weakness in a patient with known multiple sclerosis.
9.12 Why is la belle indifférence (apparent lack of concern about the symptom) not included
as a diagnostic criterion for conversion disorder (functional neurological
symptom disorder)?
A. It has poor interrater reliability.
B. It has poor specificity.
C. It has poor sensitivity.
D. It pathologizes stoicism.
E. It has poor test-retest reliability.
9.13 A 20-year-old man presents with the complaint of acute onset of decreased visual
acuity in his left eye. Physical, neurological, and laboratory examinations
are entirely normal, including stereopsis testing, fogging test, and brain magnetic
resonance imaging. The remainder of the history is negative except for
the patient’s report that since his midteens he has felt that his left cheekbone
and eyebrow are too big. He spends a lot of time comparing the right and left
sides of his face in the mirror. He is planning to have plastic surgery as soon as
he graduates from college. Which of the following diagnoses are suggested?
A. Somatic symptom disorder and delusional disorder, somatic subtype.
B. Somatic symptom disorder and illness anxiety disorder.
C. Body dysmorphic disorder and conversion disorder (functional neurological
symptom disorder).
D. Somatic symptom disorder, illness anxiety disorder, and body dysmorphic
disorder.
E. Delusional disorder, somatic subtype.
9.14 A 50-year-old man with hard-to-control hypertension acknowledges to his
physician that he regularly “takes breaks” from his medication regimen because
he was brought up with the belief that pills are bad and natural remedies
are better. He is well aware that his blood pressure becomes dangerously high
when he does not follow the regimen. Which diagnosis best fits this case?
A. Nonadherence to medical treatment.
B. Unspecified anxiety disorder.
C. Denial of medical illness.
D. Adjustment disorder.
E. Psychological factors affecting other medical conditions.
A 60-year-old man has prostate cancer with bony metastases that cause persistent
pain. He is being treated with antiandrogen medications that result in hot
flashes. Although (by his own assessment) his pain is well controlled with analgesics,
he states that he is unable to work because of his symptoms. Despite
reassurance that his medications are controlling his metastatic disease, every
instance of pain leads him to worry that he has new bony lesions and is about
to die, and he continually expresses fears about his impending death to his
wife and children. Which diagnosis best fits this patient’s presentation?
A. Panic disorder.
B. Illness anxiety disorder.
C. Somatic symptom disorder.
D. Psychological factors affecting other medical conditions.
E. Adjustment disorder with anxious mood.
9.16 A 60-year-old man with a history of coronary disease and emphysema continues
to smoke one pack of cigarettes daily despite his doctor’s clear advice that
abstinence is important for his survival. He says he’s tried to quit a dozen times
but has always relapsed due to withdrawal symptoms or feelings of tension relieved
by smoking. What is the most likely diagnosis?
A. Psychological factors affecting other medical conditions.
B. Tobacco use disorder.
C. Denial of illness.
D. Nonadherence to medical treatment.
E. Adjustment disorder.
9.17 What is the essential diagnostic feature of factitious disorder?
A. Somatic symptoms.
B. Conscious misrepresentation and deception.
C. External gain associated with illness.
D. Absence of another medical disorder that may cause the symptoms.
E. Normal physical examination and laboratory tests.
9.18 A 19-year-old man is brought to the emergency department by his family with
acute onset of hemoptysis. Although he denies any role in the genesis of the
symptom, he is observed in the waiting area to be surreptitiously inhaling a solution
that provokes violent coughing. On confrontation he eventually acknowledges
his action but explains that he heard an angel’s voice instructing
him to purify himself for a divine mission for which he will receive a heavenly
reward. He was therefore trying to expunge all “evil vapors” from his lungs
but felt obliged to keep this a secret. Why would this patient not be considered
to have factitious disorder?
A. Consequences of religious or culturally normative practices are exempt
from consideration as fabricated illnesses.
B. Factitious disorder occurs almost exclusively in women.
C. Repeated instances of illness fabrication are necessary for a diagnosis of factitious
disorder.
D. The patient expects to receive an external reward and therefore should be
considered to be malingering.
E. The presence of a psychotic illness that better accounts for the symptoms
precludes the diagnosis of factitious disorder.
9.19 When a mother knowingly and deceptively reports signs and symptoms of illness
in her preschool-aged child, resulting in the child’s hospitalization and
subjection to numerous tests and procedures, what diagnosis would be recorded
for the child?
A. Munchausen syndrome by proxy.
B. Factitious disorder by proxy.
C. No diagnosis.
D. Munchausen syndrome imposed on another.
E. Factitious disorder imposed on another.
9.20 A 25-year-old woman with a history of intravenous heroin abuse is admitted
to the hospital with infective endocarditis. Blood cultures are positive for several
fungal species. Search of the patient’s belongings discloses hidden syringes
and needles and a small bag of dirt, which, when cultured, yields the
same fungal species. Which of the following diagnoses are likely to apply?
A. Infective endocarditis, opioid use disorder, malingering, factitious disorder,
and antisocial personality disorder.
B. Opioid use disorder and malingering.
C. Infective endocarditis, opioid use disorder, and factitious disorder.
D. Malingering and antisocial personality disorder.
E. Malingering and factitious disorder.
9.21 After finding a breast lump, a 50-year-old woman with a family history of
breast cancer is overwhelmed by feelings of anxiety. Consultation with a breast
surgeon, mammogram, and biopsy show the lump to be benign. The surgeon
tells her that she requires no treatment; however, she continues to ruminate
about the possibility of cancer and surgery that will result in disfigurement.
Her sleep is restless, and she is having trouble concentrating at work. After
6 weeks of these symptoms, her primary physician refers her for psychiatric
consultation. Her medical and psychiatric history is otherwise negative. Which
diagnosis best fits this presentation?
A. Somatic symptom disorder.
B. Illness anxiety disorder.
C. Unspecified somatic symptom and related disorder.
D. Other specified somatic symptom and related disorder.
E. Adjustment disorder with anxious mood.
9.22 After finding a breast lump, a 53-year-old woman with a family history of
breast cancer is overwhelmed by feelings of anxiety. Consultation with a breast
surgeon, mammogram, and biopsy show the lump to be benign. The surgeon
indicates that she requires no treatment; however, she continues to ruminate
about the possibility of cancer and surgery that will result in disfigurement.
Her sleep is restless and she is having trouble concentrating at work. After
6 weeks in this state, her primary physician requests that she consult a psychiatrist.
On initial evaluation the patient weeps throughout the interview, and is
so distraught that the evaluator is unable to elicit details of her medical and
psychiatric history beyond reviewing the current “crisis.” Which diagnosis
best fits this presentation?
A. Somatic symptom disorder.
B. Illness anxiety disorder.
C. Unspecified somatic symptom and related disorder.
D. Other specified somatic symptom and related disorder.
E. Adjustment disorder with anxious mood.