Somatic Symptom Disorder: The Daily PANCE Blueprint
A 34-year-old female presents with vague abdominal pain, intermittent shortness of breath, and a sensation of a lump in her throat for the past nine months. Extensive workup has been unremarkable. She has significant anxiety about her symptoms, has seen multiple providers, and frequently requests additional testing. She insists something is being missed. Which of the following is the most likely diagnosis?
A. Generalized anxiety disorder
B. Illness anxiety disorder
C. Conversion disorder
D. Factitious disorder
E. Somatic symptom disorder
Answer and topic summary
The answer is E. Somatic symptom disorder
Somatic symptom disorder is defined by excessive thoughts, feelings, and/or behaviors related to somatic symptoms. Possible symptoms include unexplained shortness of breath, lump in throat, pain, dysmenorrhea, weakness, etc. People with this disorder are excessively focused on the symptoms. Clues may be that the history is vague, they are highly sensitive to medications, and they seek care from multiple providers. Here is the DSM-5 criteria:
Symptoms for > 6 months. 1 or more somatic symptoms that are distressing AND excessive thoughts, behaviors, and feelings related to symptoms in at least 1 of these ways:
- Persistent thoughts about the seriousness of symptoms
- Anxiety about symptoms
- Excessive time devoted to symptoms
Approach these people with sympathy and acknowledge their issues. Make sure they have regularly scheduled visits with one primary care provider to legitimize their concerns and provide reassurance.
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