A 38-year-old woman presents with multiple physical symptoms (pain, fatigue, GI symptoms, neurological complaints) across multiple body systems over 7 years, for which no adequate medical explanation is found. She has significant functional impairment and spends considerable time seeking medical opinions. Per DSM-5, the most appropriate diagnosis is:
- A Somatisation disorder (DSM-IV)
- B Illness Anxiety Disorder
- C Somatic Symptom Disorder (SSD) ✓
- D Functional neurological symptom disorder
Explanation
DSM-5 replaced the DSM-IV category 'Somatisation disorder' with Somatic Symptom Disorder (SSD), which no longer requires symptoms to be 'medically unexplained' but instead requires: 1+ distressing somatic symptoms, PLUS disproportionate thoughts/feelings/behaviours related to the symptoms (excessive concern, high health-related anxiety, or disproportionate time/energy), lasting >6 months. The shift acknowledges that psychological factors can amplify any physical symptom, whether or not organic pathology is present. Illness Anxiety Disorder (formerly Hypochondriasis) involves high anxiety about having a serious disease with minimal somatic symptoms. Functional neurological symptom disorder (formerly Conversion Disorder) involves neurological symptoms.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.