A 39-year-old woman presents to the clinic for 9-month history of chest pain. She explains that the pain is constant at rest but sometimes worsens with exertion. She has tried taking acetaminophen, but it does not relieve the pain. She has missed multiple days of work and family outings over this period because of the pain. Previous evaluations with many healthcare providers have included cardiac enzyme levels, electrocardiograms, chest x-ray and CT angiography, echocardiography, and an exercise stress test which have all been normal. She is anxious and frustrated that no diagnosis has been established. She has spent many hours daily searching for answers on the internet. She has no other medical problems. Vital signs and physical examination are normal. Screening for depression and generalized anxiety disorder are negative.
E) Somatic symptom disorder
Somatic symptom disorder (SSD) is a mental health condition in which a person feels significantly distressed about physical symptoms and has abnormal thoughts, feelings, and behaviors in response to them. The disorder disrupts their daily functioning and quality of life.
Although a person with somatic symptom disorder reports symptoms, the symptoms may have no medical explanation or be normal body sensations or discomfort. Even when there is a medical cause, the person’s worry is out of proportion to the symptoms.
People with somatic symptom disorder are often unaware of their underlying mental health condition and believe that they have serious physical ailments. The distress often causes them to visit multiple healthcare providers and to have many medical tests and unnecessary procedures.
Answer choice A: Conversion disorder, is incorrect. Conversion disorder involves at least one symptom of neurologic dysfunction that is unexplained by a medical condition and is not consistent with examination. These symptoms are functionally limiting and typically occur during episodes of physical, emotional or psychological stress. While people with conversion disorder frequently experience depression or anxiety, excessive worrying and distress about the physical symptoms aren’t part of the diagnosis for conversion disorder. In contrast, excessive concern about physical symptoms is the main part of the diagnosis of somatic symptom disorder.
Answer choice B: Factitious disorder, is incorrect. Factitious disorder involves falsification of symptoms with no external benefit.
Answer choice C: Illness anxiety disorder, is incorrect. Illness anxiety disorder is a mental health condition in which a person is preoccupied and excessively worried about having an illness or getting an illness. Unlike somatic symptom disorder, a person with illness anxiety disorder usually doesn’t experience physical symptoms.
Answer choice D: Malingering, is incorrect. In malingering, a person feigns medical issues for personal gain.
Key Learning Point
Somatic symptom disorder is characterized by an extreme focus on physical symptoms such as pain or fatigue that causes major emotional distress and problems functioning. There may or may not be another diagnosed medical condition associated with these symptoms, but the reaction to the symptoms is not normal.
