Unusual Psychiatric Disorders

There are some pretty fascinating psychiatric disorders that demonstrate the wide range of mental illness. When I first saw the title of a lecture on "abnormal illness-affirming behaviors," I didn't know what to expect. What does that even mean? Somatoform disorders are odd disorders in which patients have unexplainable physical symptoms. A patient might present with pain, tingling, and nausea but medical workup simply doesn't reveal anything wrong with the person. Some subtypes of somatoform disorders include conversion disorder, mass hysteria, and hypochondriasis. One extreme one, somatization or Briquet's disorder, requires 4 inexplicable different types of pain, 2 GI problems, 1 reproductive problem, and 1 neurologic symptom. In these disorders, patients aren't pretending they have illness; they really do have symptoms, and that makes it so much weirder and interesting.

In factitious disorders, patients self-induce or make up symptoms in order to "fake" being sick. Patients with disorders like Munchausen syndrome and Munchausen's by proxy like playing the "sick" role and getting medical attention. Yet the patient might not be conscious they are doing it. Quite odd when everyone else does their best to avoid doctors. This is in contrast to malingering where someone purposely and consciously fakes symptoms in order for secondary gain like getting out of work or getting a handicap sticker. Malingering is not a psychiatric illness (though it is something doctors have to deal with).

Lastly, we talked a little bit about personality disorders, a blurry subject due to the wide range of personalities and cultures that exist. Some odd or eccentric patients have paranoid or schizoid personalities while others are dramatic with borderline or narcissistic personalities while yet others act anxious and are avoidant or dependent. It's important for all physicians to learn how to identify these patients, work with them, and care for them. While I am unlikely to go into psychiatry, all of this stuff on human nature and the diversity of normal and abnormal is fun to learn.