Major Psychiatric Disorder(s): F45.1 Somatic Symptom Disorder, with predominant pain, severe
The client is a 28-year old female who reports having numerous health issues that deprive her of the possibility to work and communicate easily. These are the major issues, as identified by Catherine: her legs hurt so much that she cannot walk, her backaches frequently, she lumps that she thought to be a sign of cancer, and she has allergies when she goes outside. In the middle of the interview, she coughs slightly and says that she has a terrible cough which she considers to be a sign of pneumonia.
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The client meets several criteria for Somatic Symptom Disorder, as defined by DSM-5 (American Psychiatric Association, 2013):
- Criterion A: Catherine has more than one somatic symptoms that are disturbing her daily life (pain in legs and back, a lump, the cough);
- Criterion B: Catherine has excessive thoughts represented by constant thoughts about her symptoms, she has a high level of anxiety concerning her health, and she devotes excessive energy and time to her health concerns;
- Criterion C: The state of being symptomatic lasts longer than 6 months (Catherine reports to have had such problems for nearly ten years).
The disorder is characterized as “with predominant pain” since the client’s somatic symptoms principally incorporate pain (American Psychiatric Association, 2013, p. 311). It is severe since all three symptoms specified in Criterion B are present in the client, and somatic complaints are multiple.
Developmental Disorder(s): No developmental disorders diagnosed
The client’s language and motor skills are fine. She graduated from high school and entered college. Even though she did not finish it, she is trying to receive an education with the help of online courses.
Personality Disorder(s): No personality disorders diagnosed
Although she reports having difficulty moving, Catherine says that she sometimes goes out with her friends. Her family and friends are supportive. She does not have a boyfriend, but this is not a sufficient reason to diagnose an antisocial or avoidant personality disorder.
Medical Disorder(s): No medical disorders diagnosed
Despite the numerous complaints, the client has no outstanding medical conditions. She pays visits to doctors quite often, but they do not diagnose any illnesses.
- Clients’ parents are supportive; they take her to doctors when she complains about some health issues;
- The client has some friends with whom she can socialize;
- The client does not have any history of substance abuse;
- The client is not suicidal or homicidal;
- The client is willing to find out the reason for her problems;
- The client agrees to make more sessions with the social worker;
- The client has a high degree of aspiration; she wants to continue her education;
- Other than somatic symptom disorder, the client does not have any psychiatric illnesses;
- The client reports having good access to health care;
- The client expresses a willingness to cope with anxiety and lead a normal lifestyle.
Comments/Differential Diagnosis. (Did you consider any other possible diagnoses? Identify them here, and discuss your rationale for not selecting them. You can also use this section to discuss additional observations that helped you with your diagnostic decision making
It was clear from the start that Catherine suffered from a Somatic Symptom Disorder. I diagnosed it because the client met all the criteria (A, B, and C). Such symptoms may also refer to Generalized Anxiety Disorder since the client’s condition causes an impairment in occupational and social areas of functioning (American Psychiatric Association, 2013). However, frequent referrals to various health issues made me convinced that it was a Somatic Symptom Disorder. The client talked about several past and present issues. Even in the course of a conversation, she pretended to have a slight cough which she defined very severe and suggested that it could be pneumonia.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Publishing.