Psychosomatic symptoms are symptoms that have a psychological cause without a conclusive medical explanation, the two most common being complaints of fatigue and pain.

Though they may not necessarily be pathological, such symptoms can worsen and impair the individual’s functional ability or endanger their health, which inadvertently result in an illness. Due to the lack of substantial measurement however, psychosomatic disorders are often regarded as “not real”, and so, become subjected to stigma and judgment by society.

A 1997 World Health Organisation (WHO) study revealed that 20% of patients globally had at least six medically unexplained symptoms. A separate 2005 study in Boston also revealed that individuals with psychosomatic complaints cost the healthcare system twice as much the amount of finances as compared to other individuals.

Although psychosomatic disorders are not unfamiliar to the field of psychiatry and psychology, affected individuals usually seek help from physicians or their family doctors, and often find themselves trapped between the fields of general medicine and psychiatry. As such, it is necessary for professionals from both fields to work together to provide the best care for the patient.

Conversion disorder

Conversion disorder is the most common cause for psychosomatic symptoms – which are subconsciously triggered. Common problems include limb paralysis, difficulties in mobility, loss of muscle coordination, hearing loss or visual disturbances.

Patients may spend months or years in trying to find an organic cause for their symptoms, but often remain undiagnosed. As conversion disorders occur when the patient’s distressing or traumatic events cannot be voiced out, some treatments focus on trying to release that voice.

Though psychiatrists say that the diagnosis of conversion disorders in patients is accurate 96% of the time, most doctors are reluctant to suggest such psychological causes due to fears of upsetting their patients, facing a lawsuit, or missing a diagnosis.  In such situations however, making a diagnosis as a precaution may not be the best option as this may deny patients of appropriate treatment and exacerbate their symptoms.

Factitious disorder

Individuals with factitious disorder – such as Munchausen syndrome and Munchausen syndrome by proxy – focus on exaggerating of falsifying health problems. Patients with disorder deliberately feign or exaggerate psychological problems, physical problems, or a combination of both, in order to attain support and attention.

These individuals often complain of being unwell, or are caretakers of an ill person. However, they are usually unaware of their own motivation and are unable to control their malingering behaviour.

Tell-tale hints of factitious disorder are the exaggeration of complaints in medical histories, or symptoms that do not appear to result from illnesses or injuries. Due to the nature of the illness, treatments for individuals with factitious disorders differ from others.

Malingering not an illness, but a crime

Individuals who consciously malinger with clear motivations may become evasive and may even avoid turning up for scheduled follow-ups or cancelling hospital appointments for fear of being found out.

Based on the Diagnostic and Statistical Manual (DSM), malingering is not considered a medical diagnosis but a serious offence. These unscrupulous individuals may feign illness for financial reasons, to win a court case, avoid conscription, or to get hold of controlled medications. Such individuals usually have previous involvement of lawyers in medical issues, poor compliance with treatments prescribed by the doctor or inconsistencies in their symptoms.

A huge challenge for doctors is that patients with conversion disorders may be wrongly accused of malingering. As such, when healthcare professionals suspect discrepancies in a patient, they should take extra caution to ensure they have sufficient evidence against the individual before claiming that he is malingering.

On top of fearing a wrong accusation could be made on a conversion disorder patient, the sufferings of the patient associated with monetary gains or court cases could also be subjective to the individual. However, most doctors often see it as their duty to trust that their patient is genuine in his illness, and some believe that it might be better to miss the rare non-genuine few instead of alienating and demeaning the others with a false accusation. MIMS

Read more:
Psychosomatic illnesses: ‘It’s all in the mind’ is not the answer
Why do some patients lie?
5 peculiar mental disorders

O'Sullivan, Suzanne. It's All in Your Head: Stories from the Frontline of Psychosomatic Illness. London: Vintage, 2016. Print.