A Case of Somatic Symptom Disorder, Case Study Example

The case

The client is a lady who is referred by her doctor for evaluation due to symptoms of the somatic disorder. She is accompanied by one of her friend who she says have been very supportive.  From the interview with the physician, we learn that the symptoms started five years ago after the death of her husband. The client seems to be lonely although she has friends and family. It is clear when she reports that it has been hard being on her own and taking care of herself.  She reports that her whole body is in pain. Sometimes, the pain makes her not to work, cook or bath. She also reports that she had sort help from other doctors who didn’t seem to figure out what is wrong since all of their intervention has failed. She categorically reports that one doctor recommends her for pain management, which she found to be very discomforting because she does not take drugs. When the physician allows her to describe the accident she explains how horrible it was. The client seems to exaggerate the accident. She says she was hurt but from the examination she had no injuries, and thus doctors released her.

From the information gathered from the client history, the following differential diagnosis can be posited.

Diagnostic criterion

1. One or more somatic symptom that are distressing or result in significant disruption of daily life. (American Psychiatric Association, 2013)

The client meets the criterion A because she has multiple somatic symptoms including pain. She reports that she experience localized pain and specific pain. She says that the whole body hurt, then she specify that her arms, stomach and throat hurts.  The pain has led to disruptions in her daily life; she reports that there are days she cannot go to work can’t cook or bath all she does is lay in bed all day long.  Also, she says that she has not been able to drive herself from the day of the accident.

1. Excessive feeling, thoughts or behaviors related to the somatic symptom or associated health concern as manifested by at least one of the following: inappropriateness and persistence thought about the seriousness of one symptom, persistently high level of anxiety about health symptom. And excessive time devoted to these symptom or health concerns (American Psychiatric Association, 2013)

The client meet criterion B because she has very high level of worry about her illness. She appraises her bodily symptom as unduly threatening, harmful and troublesome and often thinks the worse of her health. It is clear when she reports that the crash hurt her, and there seem to be nothing to cure her. However, this is contrary to a medical examination done after the crash in the EI, which revealed that she had no injuries, and thus the doctors released her.  Despite the examination, the client still believes the crash seriously hurt her. She even reports that she is suing the doctors who said that she was not hurt. Also, the client had sorted help from multiple doctors for similar symptoms, and she was unresponsive to all other medical interventions. It increases her worry as she feels that nobody seem to understand her.

1. Although anyone somatic symptom may not be continuously present, the state of being symptomatic is persistent for more than six months. (American Psychiatric Association, 2013)

The client meets Criterion C because most of the somatic symptom that she experience has been persistence soon after her husband died which is five years ago. She reports that her stomach and her throat hurt since the clash

More specification

The client somatic symptom is with predominant pain; that is the symptoms predominantly involve pain

The client somatic symptoms are persistence because she has been experiencing severe pain for five years

Severity:  the client somatic symptom disorder is severe because she meets the all three symptoms specified in criterion B. Besides she has severe somatic symptoms.

Since the client symptom meets criterion A, B and C we can conclude that she has severe somatic symptom disorder that need to be treated.

Reference

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association.