A 35-year-old woman presents with multiple medically unexplained symptoms — fatigue, pain in multiple areas, bloating — for 4 years. She spends excessive time reading about these symptoms online, frequently visits different physicians, and rates health anxiety as severely impairing. In DSM-5, the MOST likely diagnosis is:

• A Somatic Symptom Disorder (SSD) with predominant pain ✓
• B Illness Anxiety Disorder (hypochondriasis)
• C Functional Neurological Symptom Disorder
• D Factitious Disorder Imposed on Self

Explanation

DSM-5 Somatic Symptom Disorder (SSD) requires: ≥1 somatic symptom causing distress/functional impairment plus excessive thoughts/feelings/behaviours related to the symptoms (disproportionate, persistent anxiety, excessive time/energy devoted). SSD can be diagnosed even when a medical condition co-exists. Illness Anxiety Disorder (formerly hypochondriasis) involves high health anxiety with minimal or absent somatic symptoms — the patient fears having a serious illness rather than experiencing prominent symptoms. This patient's multiple physical symptoms plus excessive symptom-focused behaviours fits SSD. Factitious disorder involves deliberate feigning.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.