++
Patients with somatic symptom disorders present with prominent physical symptoms; these are associated with significant distress or impairment in social, occupational, or other areas of functioning. While these patients may or may not have an associated medical condition, their focus is on their distressing somatic symptoms as well as their thoughts, feelings, and behaviors in response to these symptoms.
++
++
Up to 30% of primary care patients present with medically unexplained symptoms. In many cases, unspoken psychological needs manifest as physical symptoms. The symptoms may not make physiological “sense” but rather follow the patient's conception of how their body works.
++
Ms. Thomas is a 31-year-old woman who was referred to a psychiatrist by her gynecologist after undergoing multiple exploratory surgeries for abdominal pain and gynecologic concerns with no definitive findings. The patient reports that she has had extensive medical problems dating back to adolescence. She reports periods of extreme abdominal pain, vomiting, diarrhea, and possible food intolerances. The obstetrician is her fourth provider because “my other doctors were not able to help me.” Ms. Thomas reports fear that her current physician will also fail to relieve her distress. She was reluctant to see a psychiatrist and did so only after her obstetrician agreed to follow her after her psychiatric appointment.
Ms. Thomas states that her problems worsened in college, which was the first time she underwent surgery. She reports that due to her health problems and severe lack of energy, it took her 5½ years to graduate from college. She did better for a year or two after college but then had a return of symptoms. She reports recently feeling very lonely and isolated because she has not been able to find a boyfriend who can tolerate her frequent illnesses. She also reports that physical intimacy is difficult for her because she finds sex painful. Additionally, she is concerned that she might lose her job due to the number of days she has missed from work due to her abdominal pain, fatigue, and weakness.
What is the diagnosis?
Somatic symptom disorder. Ms. Thomas has a history of multiple somatic complaints lasting at least 6 months, along with a high level of anxiety about her symptoms and excessive time and energy devoted to her health concerns. She has had multiple medical procedures and significant impairment in her social and occupational functioning.
+++
SOMATIC SYMPTOM DISORDER
++
Patients with somatic symptom disorder present with at least one (and often multiple) physical symptom. They frequently seek treatment from many doctors, often resulting in extensive lab work, diagnostic procedures, hospitalizations, and/or surgeries. Note that somatic symptom disorder and a related ...