Behave Anxiety Somatoform Disorder

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  • 1/24 Questions

    Questions 1-3 A 23-year-old medical student comes to the emergency room with increased heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks. She has no history of asthma and, other than an increased pulse rate, physical findings are unremarkable.   Which of the following disorders best fits this clinical picture?

    • Hypochondriasis
    • Obsessive-compulsive disorder
    • Panic disorder
    • Generalized anxiety disorder
    • Acute stress disorder
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Anxiety Quizzes & Trivia
About This Quiz

Somatoform disorder is any mental disorder, which manifests as physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition. Issues such as anxiety disorders can cause this disorder. Take up this quiz and see how much you know about behavior when it comes to anxiety somatoform disorder.

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  • 2. 

    Questions 1-3 A 23-year-old medical student comes to the emergency room with increased heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks. She has no history of asthma and, other than an increased pulse rate, physical findings are unremarkable.   Of the following, the most effective immediate treatment for this patient is

    • An antidepressant

    • A support group

    • A benzodiazepine

    • Buspirone

    • A β-blocker

    Correct Answer
    A. A benzodiazepine
    Explanation
    The most effective immediate treatment for this patient is a benzodiazepine. The patient is experiencing symptoms of anxiety, such as increased heart rate, sweating, and shortness of breath. These symptoms are not consistent with an asthma attack, as the patient has no history of asthma and physical findings are unremarkable. Benzodiazepines are commonly used to treat anxiety and can provide immediate relief of symptoms. Antidepressants, support groups, buspirone, and β-blockers are not the most appropriate options for immediate treatment of acute anxiety symptoms.

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  • 3. 

    Questions 1-3 A 23-year-old medical student comes to the emergency room with increased heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks. She has no history of asthma and, other than an increased pulse rate, physical findings are unremarkable.   Of the following, the most effective long-term treatment for this patient is

    • An antidepressant

    • A support group

    • A benzodiazepine

    • Buspirone

    • A β-blocker

    Correct Answer
    A. An antidepressant
    Explanation
    The answer is A. This patient is showing evidence of panic disorder. Panic disorder is characterized by panic attacks, which include increased heart rate, dizziness, sweating, shortness of breath, and fainting, and the conviction that one is about to die. Attacks commonly occur twice weekly, last about 30 minutes, and are most common in young women, such as this patient. While the most effective immediate treatment for this patient is a benzodiazepine because it works quickly, the most effective long-term (maintenance) treatment is an antidepressant, particularly a selective serotonin reuptake inhibitor (SSRI) such as paroxetine (Paxil).

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  • 4. 

    Questions 4 and 5 A 35-year-old woman who was raped 5 years ago has recurrent vivid memories of the incident accompanied by intense anxiety. These memories frequently intrude during her daily activities, and nightmares about the event often wake her. Her symptoms intensified when a coworker was raped 2 months ago.   This patient's symptoms most closely suggest

    • Post-traumatic stress disorder

    • Panic disorder

    • Adjustment disorder

    • Acute stress disorder

    • Malingering

    Correct Answer
    A. Post-traumatic stress disorder
    Explanation
    The patient's symptoms of recurrent vivid memories, intense anxiety, intrusive thoughts, nightmares, and symptom intensification after a recent traumatic event (coworker being raped) are consistent with post-traumatic stress disorder (PTSD). PTSD is a psychiatric disorder that can occur after experiencing or witnessing a traumatic event, and it is characterized by intrusive symptoms, avoidance behaviors, negative mood, and alterations in arousal and reactivity. Panic disorder and adjustment disorder may have some overlapping symptoms, but they do not fully capture the range and intensity of symptoms described in the case. Acute stress disorder is a possibility, but the duration of the symptoms (5 years) suggests a diagnosis of PTSD. Malingering is not a valid explanation as the symptoms are consistent with a genuine psychiatric condition.

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  • 5. 

    Questions 4 and 5 A 35-year-old woman who was raped 5 years ago has recurrent vivid memories of the incident accompanied by intense anxiety. These memories frequently intrude during her daily activities, and nightmares about the event often wake her. Her symptoms intensified when a coworker was raped 2 months ago. Of the following, the most effective long-term treatment for this patient is

    • An antidepressant

    • A support group

    • A benzodiazepine

    • Buspirone

    • A β-blocker

    Correct Answer
    A. A support group
    Explanation
    The answer is B. This patient is most likely to have post-traumatic stress disorder (PTSD). This disorder, which is characterized by symptoms of anxiety and intrusive memories and nightmares of a life-threatening event such as rape, can last for many years in chronic form and may have been intensified in this patient by reexperiencing her own rape through the rape of her coworker. The most effective long-term treatment for this patient is a support group, in this case a rape survivor's group. Pharmacologic treatment can be used as an adjunct to psychological treatment.

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  • 6. 

    Questions 6-8 A 45-year-old woman says that she frequently feels "nervous" and often has an "upset stomach," which includes heartburn, indigestion, and diarrhea. She has had this problem since she was 25 years of age and notes that other family members also are "tense and nervous."   Which of the following disorders best fits this clinical picture?

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Generalized anxiety disorder

    • Acute stress disorder

    Correct Answer
    A. Generalized anxiety disorder
    Explanation
    The woman's symptoms of feeling "nervous" and having an upset stomach, including heartburn, indigestion, and diarrhea, are consistent with the criteria for generalized anxiety disorder. Additionally, the fact that she has had this problem since she was 25 years old and that other family members also experience being "tense and nervous" suggests a pattern of chronic anxiety that is characteristic of generalized anxiety disorder.

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  • 7. 

    Questions 6-8 A 45-year-old woman says that she frequently feels "nervous" and often has an "upset stomach," which includes heartburn, indigestion, and diarrhea. She has had this problem since she was 25 years of age and notes that other family members also are "tense and nervous."   Which of the following additional signs or symptoms is this patient most likely to show?

    • Flight of ideas

    • Hallucinations

    • Tingling in the extremities

    • Ideas of reference

    • Neologisms

    Correct Answer
    A. Tingling in the extremities
    Explanation
    The patient's symptoms of feeling "nervous" and having an "upset stomach" are suggestive of anxiety and gastrointestinal issues. The mention of other family members being "tense and nervous" suggests a possible genetic or familial predisposition to anxiety. Tingling in the extremities can be a common physical symptom of anxiety, known as paresthesia. Therefore, it is likely that this patient may also experience tingling in her extremities as an additional sign or symptom.

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  • 8. 

    Questions 6-8 A 45-year-old woman says that she frequently feels "nervous" and often has an "upset stomach," which includes heartburn, indigestion, and diarrhea. She has had this problem since she was 25 years of age and notes that other family members also are "tense and nervous."   Of the following, the most effective long-term treatment for this patient is

    • Alprazolam (Xanax)

    • Psychotherapy

    • Propranolol (Inderal)

    • Buspirone (BuSpar)

    • Diazepam (Valium)

    Correct Answer
    A. Buspirone (BuSpar)
    Explanation
    The answer is D. This patient is most likely to have generalized anxiety disorder (GAD). This disorder, which includes chronic anxiety and gastrointestinal symptoms over a prolonged period, is more common in women and often starts in the 20s. Genetic factors are seen in the observation that other family members have similar problems with anxiety. Additional signs or symptoms of anxiety that this patient is likely to show include tingling in the extremities, often resulting from hyperventilation. Flight of ideas, hallucinations, ideas of reference, and neologisms are psychotic symptoms, which are not seen in the anxiety disorders or the somatoform disorders. Of the choices, the most effective long-term treatment for this patient is buspirone because, unlike the benzodiazepine alprazolam, it does not cause dependence or withdrawal symptoms with long-term use. The antidepressants venlafaxine and duloxetine and SSRIs also are effective for long-term treatment of GAD. Psychotherapy and β-blockers can be used as adjuncts to treat GAD, but are not the most effective long-term treatments.

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  • 9. 

    A 39-year-old woman claims that she injured her hand at work. She asserts that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a $30,000 workers' compensation settlement. This clinical presentation is an example of

    • Factitious disorder

    • Conversion disorder

    • Factitious disorder by proxy

    • Somatization disorder

    • Somatoform pain disorder

    • Malingering

    Correct Answer
    A. Malingering
    Explanation
    The answer is F. This presentation is an example of malingering, feigning illness for obvious gain (the $30,000 workers' compensation settlement). Evidence for this is that the woman has no further hand problems after she receives the money. In conversion disorder, somatization disorder, factitious disorder, and factitious disorder by proxy there is no obvious or material gain related to the symptoms.

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  • 10. 

    Which of the following events is most likely to result in post-traumatic stress disorder (PTSD)?

    • Divorce

    • Bankruptcy

    • Diagnosis of diabetes mellitus

    • Changing residence

    • Robbery at knifepoint

    Correct Answer
    A. Robbery at knifepoint
    Explanation
    The answer is E. Robbery at knifepoint, a life-threatening event, is most likely to result in post-traumatic stress disorder (PTSD). While life events such as divorce, bankruptcy, illness, and changing residence are stressful, they are rarely life threatening. Psychological symptoms occurring after such less severe events may result in adjustment disorder, not PTSD.

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  • 11. 

    Questions 11 and 12 A 39-year-old woman takes her 6-year-old son to a physician's office. She says that the child often experiences episodes of breathing problems and abdominal pain. The child's medical record shows many office visits and four abdominal surgical procedures, although no abnormalities were ever found. Physical examination and laboratory studies are unremarkable. When the doctor confronts the mother with the suspicion that she is fabricating the illness in the child, the mother angrily grabs the child and leaves the office immediately.   This clinical presentation is an example of

    • Factitious disorder

    • Conversion disorder

    • Factitious disorder by proxy

    • Somatization disorder

    • Somatoform pain disorder

    • Malingering

    Correct Answer
    A. Factitious disorder by proxy
    Explanation
    This clinical presentation is an example of factitious disorder by proxy. Factitious disorder by proxy, also known as Munchausen syndrome by proxy, is a condition in which a caregiver, usually a parent, fabricates or induces illness in another person, typically a child. In this case, the mother is bringing her son to the physician's office multiple times with complaints of breathing problems and abdominal pain, but no abnormalities are found. The fact that the mother becomes angry and leaves the office when confronted with suspicion suggests that she may be intentionally causing or exaggerating the child's symptoms.

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  • 12. 

    Questions 11 and 12 A 39-year-old woman takes her 6-year-old son to a physician's office. She says that the child often experiences episodes of breathing problems and abdominal pain. The child's medical record shows many office visits and four abdominal surgical procedures, although no abnormalities were ever found. Physical examination and laboratory studies are unremarkable. When the doctor confronts the mother with the suspicion that she is fabricating the illness in the child, the mother angrily grabs the child and leaves the office immediately.   In this situation, what is the first thing the physician should do?

    • Take the child aside and ask him how he feels

    • Call a pediatric pulmonologist to determine the cause of the dyspnea.

    • Call a pediatric gastroenterologist to determine the cause of the abdominal pain.

    • Notify the appropriate state social service agency to report the physician's suspicions.

    • Wait until the child's next visit before taking any action

    Correct Answer
    A. Notify the appropriate state social service agency to report the physician's suspicions.
    Explanation
    The answer is D. This presentation is an example of factitious disorder by proxy. The mother has feigned the child's illness (episodes of breathing problems and abdominal pain) for attention from medical personnel. This faking has resulted in four abdominal surgical procedures in which no abnormalities were found. Since she knows she is lying, the mother will become angry and flee when confronted with the truth. The first thing the physician must do is to notify the state social service agency since factitious disorder by proxy is a form of child abuse. Waiting until the child's next visit before acting could result in the child's further injury or even death. Calling in specialists may be appropriate after the physician reports his suspicions to the state. It is not appropriate to take the child aside and ask him how he really feels. He probably is unaware of his mother's behavior.

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  • 13. 

    A 45-year-old woman has a 20-year history of vague physical complaints including nausea, painful menses, and loss of feeling in her legs. Physical examination and laboratory workup are unremarkable. She says that she has always had physical problems but that her doctors never seem to identify their cause. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Somatization disorder
    Explanation
    The answer is E. This woman with a 20-year history of unexplained vague and chronic physical complaints probably has somatization disorder. This can be distinguished from hypochondriasis, which is an exaggerated worry about normal physical sensations and minor ailments (see also answers 14-19).

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  • 14. 

    Three months after moving, a teenager who was formerly outgoing and a good student seems sad, loses interest in making friends, and begins to do poor work in school. His appetite is normal and there is no evidence of suicidal ideation. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Adjustment disorder
    Explanation
    The answer is K. This teenager, who was formerly outgoing and a good student and now seems sad, loses interest in making friends, and begins to do poor work in school, probably has adjustment disorder (with depressed mood). It is likely that he is having problems adjusting to his new school. In contrast to adjustment disorder, in masked depression the symptoms are more severe and often include significant weight loss and suicidality.

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  • 15. 

    A 29-year-old man experiences a sudden hemiparesis, but appears unconcerned. He reports that just before the onset of paralysis, he saw his girlfriend with another man. Physical examination fails to reveal evidence of a medical problem. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Conversion disorder
    Explanation
    The answer is H. This man, who experiences a sudden paralysis triggered by seeing his girlfriend with another man, is showing evidence of conversion disorder. This disorder is characterized by an apparent lack of concern about the symptoms (i.e., la belle indifférence).

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  • 16. 

    A 41-year-old man says that he has been "sickly" for most of his life. He has seen many doctors but is angry with most of them because they ultimately referred him for psychological help. He now fears that he has stomach cancer because his stomach makes noises after he eats. Physical examination is unremarkable and body weight is normal. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Hypochondriasis
    Explanation
    The answer is B. This man, who says that he has been "sickly" for most of his life and fears that he has stomach cancer, is showing evidence of hypochondriasis, exaggerated concern over normal physical sensations (e.g., stomach noises) and minor ailments. There are no physical findings or obvious evidence of depression in this patient.

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  • 17. 

    A 41-year-old man says that he has been "sickly" for the past 3 months. He fears that he has stomach cancer. The patient is unshaven and appears thin and slowed down. Physical examination, including a gastrointestinal workup, is unremarkable except that the patient has lost 15 pounds since his last visit 1 year ago. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Masked depression
    Explanation
    The answer is L. This man, who says that has been "sickly" for the past 3 months and fears that he has stomach cancer, probably has masked depression. In contrast to the hypochondriacal man in the previous question, evidence for depression in this patient includes the fact that, in addition to the somatic complaints, he shows symptoms of depression (e.g., he is not groomed, appears slowed down [psychomotor retardation], and has lost a significant amount of weight).

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  • 18. 

    A 28-year-old woman seeks facial reconstructive surgery for her "sagging" eyelids. She rarely goes out in the daytime because she believes that this characteristic makes her look "like a grandmother." On physical examination, her eyelids appear completely normal. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Body dysmorphic disorder
    Explanation
    The answer is G. This woman probably has body dysmorphic disorder, which is characterized by over-concern about a physical feature (e.g., "sagging" eyelids in this case), despite normal appearance

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  • 19. 

    A 29-year-old man is upset because he must take a client to dinner in a restaurant. Although he knows the client well, he is so afraid of making a mess while eating that he says he is not hungry and sips from a glass of water instead of ordering a meal. Which disorder best fits this clinical picture?

    • Post-traumatic stress disorder

    • Hypochondriasis

    • Obsessive-compulsive disorder

    • Panic disorder

    • Somatization disorder

    • Generalized anxiety disorder

    • Body dysmorphic disorder

    • Conversion disorder

    • Specific phobia

    • Social phobia

    • Adjustment disorder

    • Masked depression

    Correct Answer
    A. Social phobia
    Explanation
    The answer is J. This man probably has social phobia. He is afraid of humiliating himself in a public situation (e.g., eating dinner in front of others in a restaurant).

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  • 20. 

    A 35-year-old nurse is brought to the emergency room after fainting outside of a patient's room. The nurse notes that she has had fainting episodes before and that she often feels weak and shaky. Laboratory studies reveal hypoglycemia, very high insulin level, and suppressed plasma C peptide. Which of the following best fits this clinical picture?

    • A sleep disorder

    • A seizure disorder

    • A somatoform disorder

    • Malingering

    • An endocrine disorder

    • A factitious disorder

    Correct Answer
    A. A factitious disorder
    Explanation
    The answer is F. The triad of hypoglycemia, very high insulin level, and suppressed plasma C peptide indicates that this nurse has self-administered insulin, a situation known as factitious hyperinsulinism. In hyperinsulinism due to medical causes, e.g., insulinoma (pancreatic B-cell tumor), plasma C peptide is typically increased, not decreased. Factitious disorder is more common in people associated with the health professions. There is no evidence in this woman of a sleep disorder, seizure disorder, somatoform disorder, or endocrine disorder such as diabetes. Because there is no obvious or practical gain for this woman in being ill, malingering is unlikely.

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  • 21. 

    A 22-year-old man is brought into the emergency room by the police. The policeman tells the physician that the man was caught while attempting to rob a bank. When the police told him to freeze and drop his gun, the man dropped to the floor and could not speak, but remained conscious. When the doctor attempts to interview him, the patient repeatedly falls asleep. The history reveals that the patient's brother has narcolepsy. Which of the following best fits this clinical picture?

    • A sleep disorder

    • A seizure disorder

    • A somatoform disorder

    • Malingering

    • An endocrine disorder

    • A factitious disorder

    Correct Answer
    A. Malingering
    Explanation
    The answer is D. When there is financial or other obvious gain to be obtained from an illness, the possibility that the person is malingering should be considered. In this case, a man who has committed a crime is feigning symptoms of narcolepsy to avoid prosecution. Knowledge of the details of his brother's illness has allowed him to feign the cataplexy (sudden loss of motor control) and daytime sleepiness associated with narcolepsy.

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  • 22. 

    Questions 22 and 23 A 12-year-old boy is admitted to the hospital with a diagnosis of "pain of unknown origin." His parents tell the physician that the child has complained about pain in his legs for about 1 month. Neurologic and orthopedic examinations fail to identify any pathology. The history reveals that the child was hospitalized on two previous occasions for other pain symptoms for which no cause was found. After 4 days in the hospital, the nurse reports that the child shows little evidence of pain and seems "remarkably content." She also reports that she found a medical textbook in the boy's bedside table with a bookmark in the section entitled "skeletal pain of unknown origin."     Which of the following best fits this clinical picture?

    • A sleep disorder

    • A seizure disorder

    • A somatoform disorder

    • Malingering

    • An endocrine disorder

    • A factitious disorder

    Correct Answer
    A. A factitious disorder
    Explanation
    A factitious disorder is characterized by the intentional production or feigning of physical or psychological symptoms in order to assume the sick role. In this case, the child's behavior suggests that he may be intentionally producing or exaggerating his pain symptoms, as evidenced by his contentment in the hospital and his bookmarked textbook on skeletal pain of unknown origin. This behavior is consistent with a factitious disorder.

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  • 23. 

    Questions 22 and 23 A 12-year-old boy is admitted to the hospital with a diagnosis of "pain of unknown origin." His parents tell the physician that the child has complained about pain in his legs for about 1 month. Neurologic and orthopedic examinations fail to identify any pathology. The history reveals that the child was hospitalized on two previous occasions for other pain symptoms for which no cause was found. After 4 days in the hospital, the nurse reports that the child shows little evidence of pain and seems "remarkably content." She also reports that she found a medical textbook in the boy's bedside table with a bookmark in the section entitled "skeletal pain of unknown origin."     Which of the following best describes symptom production and motivation in this case?

    • Symptom production conscious, motivation primarily conscious

    • Symptom production unconscious, motivation primarily conscious

    • Symptom production conscious, motivation primarily unconscious

    • Symptom production unconscious, motivation primarily unconscious

    Correct Answer
    A. Symptom production conscious, motivation primarily unconscious
    Explanation
    The answer is C. This clinical presentation is an example of factitious disorder (note: most axis I disorders can also be seen in children). In contrast to patients with somatoform disorders who really believe that they are ill, patients with factitious disorder are conscious of the fact that they are feigning their illness. Pain is one of the most commonly feigned illnesses and this patient's nighttime reading is providing him with specific knowledge of how to feign the symptoms realistically. Although he is consciously producing his symptoms, this boy is not receiving tangible benefit for his behavior. Thus, in contrast to individuals who are consciously feigning illness for obvious gain, i.e., malingering (see question 21), the motivation for this patient's faking behavior is primarily unconscious.

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  • 24. 

    A 40-year-old man tells his physician that he is often late for work because he has difficulty waking up on time. He attributes this problem to the fact that he gets out of bed repeatedly during the night to recheck the locks on the doors and to be sure the gas jets on the stove are turned off. His lateness is exacerbated by his need to count all of the traffic lights along the route. If he suspects that he missed a light, he becomes quite anxious and must then go back and recount them all. Physical examination and laboratory studies are unremarkable. Of the following, the most effective long-term treatment for this patient is most likely to be

    • An antidepressant

    • An antipsychotic

    • A benzodiazepine

    • Buspirone

    • A β-blocker

    Correct Answer
    A. An antidepressant
    Explanation
    The answer is A. The most effective long-term treatment for OCD is an antidepressant such as clomiprimine (see also answer to the Typical Board Question) or an SSRI.

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  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Sep 21, 2012
    Quiz Created by
    Chachelly

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