Review Question - QID 106886

The patient is most likely suffering from somatic symptom disorder - a condition where a patient experiences physical symptoms suggestive of injury or illness that cannot be explained by a medical condition, an alternative mental disorder, or the use of substances.

According to the DSM-5, somatic symptom disorder can be diagnosed when somatic symptoms are very distressing to a patient or disrupt normal function, and when disproportionate thoughts, feelings, or behaviors are presented due to these symptoms. In order to make the diagnosis, symptoms must persist for at least 6 months.

Oyama et al. write that somatoform disorders should be considered when patients present with unexplained physical symptoms. Discussing the possibility of Somatic Symptom Disorder with a patient early on in the evaluative process may prevent unnecessary tests and treatments. A patient may be referred to a mental health professional when necessary.

Somashaker et al. suggest that, although all classes of psychotropics and antidepressants are used to treat Somatic Symptom Disorder, cognitive behavioral therapy is a beneficial option, and the combination of behavior therapy and medication should be considered.

Incorrect Answers:
Answer 2: Functional neurologic symptom disorder is a presentation of symptoms with seemingly neurologic causes, but without a physiological explanation. The symptoms this patient presents with are not neurologic in nature.
Answer 3: Hypochondriasis, or illness anxiety disorder, is persistent fear and anxiety over having or getting diseases without any or minimal symptoms.
Answer 4: Factitious disorder is a condition in which a person makes herself or himself ill or exaggerates symptoms in order to gain attention or sympathy – this patient did not intentionally make herself sick.
Answer 5: Body dysmorphic disorder is when an individual’s concern over body image manifests as an excessive concern with a perceived physical defect.