A nurse is providing care to a client who was admitted to the emergency department with superficial lacerations on their leg. The client states, "I was feeling bored, so I used a pair of gardening scissors to cut myself." The client denies current depression and suicidal thoughts. The client is demonstrating manifestations of which of the following disorders?
Somatic symptom disorder
Illness anxiety disorder
Factitious disorder
Functional neurological symptom disorder
The Correct Answer is C
A. Somatic symptom disorder. This disorder involves experiencing physical symptoms that cause significant distress or impairment, typically related to an underlying medical condition. The client’s actions do not reflect a focus on physical symptoms for relief of anxiety or distress in the same way.
B. Illness anxiety disorder. This disorder is characterized by excessive worry about having a serious illness despite minimal or no symptoms. The client’s behavior of intentionally cutting themselves does not align with this disorder, as there is no indication of anxiety over illness.
C. Factitious disorder. This disorder involves intentionally producing or feigning symptoms for the purpose of assuming the sick role, without external incentives. The client’s admission of boredom as the reason for self-harm indicates an intent to create a situation for attention or care, aligning with factitious disorder.
D. Functional neurological symptom disorder. This condition involves neurological symptoms that cannot be explained by medical findings, often presenting as involuntary symptoms. The client’s self-inflicted injuries are not indicative of this disorder, as they intentionally engaged in self-harm.
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Correct Answer is C
Explanation
A. Dissociative amnesia. This condition involves memory loss of personal information or past events due to psychological stress or trauma. It does not cause physical symptoms like numbness or an inability to grip the steering wheel.
B. Depersonalization/derealization disorder. This disorder causes feelings of detachment from oneself (depersonalization) or the environment (derealization). While distressing, it does not typically result in sensory or motor deficits such as hand numbness.
C. Functional neurological symptom disorder. Formerly known as conversion disorder, this condition involves neurological symptoms, such as numbness or paralysis, that cannot be explained by a medical condition. The symptoms are often triggered by psychological stress, such as anxiety related to driving.
D. Factitious disorder. Factitious disorder involves deliberately fabricating or inducing symptoms to assume the sick role. In this case, the client is describing involuntary symptoms that appear to have a psychological basis rather than being intentionally produced.
Correct Answer is D
Explanation
A. Nausea and vomiting. While some antipsychotic medications may cause gastrointestinal side effects, nausea and vomiting are not characteristic of tardive dyskinesia. Tardive dyskinesia specifically affects involuntary motor control.
B. Hallucinations and delusions. These are symptoms of psychotic disorders, not side effects of tardive dyskinesia. While some antipsychotic medications can cause paradoxical worsening of psychosis, tardive dyskinesia primarily involves involuntary movements rather than psychiatric symptoms.
C. Seizures and tremors. Some antipsychotics lower the seizure threshold, increasing seizure risk, while tremors are more associated with drug-induced parkinsonism. However, these are different from the repetitive, involuntary movements seen in tardive dyskinesia.
D. Uncontrolled movements around the mouth. Tardive dyskinesia is a serious side effect of long-term antipsychotic use, characterized by involuntary movements, especially around the mouth, tongue, and face (e.g., lip smacking, tongue protrusion, and grimacing). These movements can become permanent, making early detection and intervention crucial.
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