Somatic Symptom Disorder: The Daily PANCE Blueprint
A 41-year-old female presents to your clinic complaining of shortness of breath, weakness, and pain in her throat for the past year. She says she has been to multiple specialists for her symptoms, but all work-ups have been unremarkable. She can’t take pain medications to help since all of them give her a headache. She is extremely concerned and distressed about her symptoms. Which of the following is the most likely diagnosis?
A. Factitious disorder
B. Malingering disorder
C. Somatic symptom disorder
D. Conversion disorder
E. Dissociative disorder
Answer and topic summary
The answer is C. 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, emesis, 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 symptom that is distressing AND excessive thoughts/behaviors/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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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Psychiatry ⇒
Also covered as part of the Psychiatry EOR topic list
