A 38-year-old woman with somatic symptom disorder has seen nine specialists in eighteen months, accumulating repeated normal investigations and increasing iatrogenic harm. Which management strategy has the strongest evidence base and should be instituted first?
- A Long-term low-dose antipsychotic therapy targeting the somatic preoccupation
- B Reassurance after each new set of investigations ordered by whichever specialist she requests
- C Regularly scheduled short visits with a single designated physician, limiting investigations to objective indications ✓
- D Admission for inpatient workup of each new symptom to exclude organic disease definitively
Correct answer: C. Regularly scheduled short visits with a single designated physician, limiting investigations to objective indications
Explanation
The cornerstone of management is a consistent therapeutic alliance: brief, regularly scheduled visits with one identified physician, with examinations and investigations restricted to objective indications. Scheduled visits decouple the visit from new symptoms and reduce crisis-driven doctor shopping. Ordering tests to reassure, or admitting for repeat workups, reinforces illness behaviour and exposes the patient to further iatrogenic harm, while antipsychotics have no established role.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.