A 35-year-old woman presents with persistent, distressing abdominal pain, fatigue, and headaches lasting 18 months. Extensive investigations are normal. She is highly preoccupied with the possibility of a serious underlying illness, frequently checks her body, and seeks repeated medical consultations. Her preoccupation persists even after thorough reassurance. Which DSM-5-TR diagnosis best fits?
- A Illness anxiety disorder
- B Conversion disorder
- C Factitious disorder
- D Somatic symptom disorder ✓
Explanation
Somatic symptom disorder requires one or more distressing somatic symptoms plus disproportionate and persistent thoughts about symptom seriousness, high anxiety about health, and excessive time and energy devoted to symptoms, lasting more than six months. The key is that the distress and dysfunction arise from both the somatic symptoms AND the abnormal illness-related cognitions and behaviours. Illness anxiety disorder involves high health anxiety with minimal or absent somatic symptoms. Conversion disorder requires one or more neurological symptoms incompatible with recognised neurological conditions.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.