A patient is having anxiety, headache due to stress, or feeling physically weak after trauma and sometimes diarrhoea and constipation due to overthinking. On the basis of signs & symptoms, the diagnosis would be?

Appeared in: Central Institute of Psychiatry - 9 July 2022

Explanation

Somatisation disorder (now primarily termed Somatic Symptom Disorder) is characterized by one or more distressing physical symptoms.
These symptoms are accompanied by excessive and disproportionate thoughts, feelings, and behaviors related to them.
The patient's presentation fits this diagnosis perfectly, with multiple symptoms (headache, weakness, GI issues) across different body systems that are directly attributed to psychological factors like stress and anxiety.

Why Other Options Were Wrong

Option A: Irritable Bowel Syndrome (IBS) is a functional disorder of the gut. While it explains the diarrhoea and constipation linked to stress, it does not account for the patient's headache or generalized physical weakness.
Option C: Conversion disorder involves specific neurological symptoms (e.g., paralysis, blindness, non-epileptic seizures) that are incompatible with a known neurological or medical condition. The patient's symptoms are more generalized and not of this nature.
Option D: Factitious disorder involves the conscious and intentional production or feigning of symptoms to assume the sick role. There is no information in the scenario to suggest the patient is deliberately deceiving healthcare providers.

Related Visual

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Differential diagnosis of somatoform and related disorders based on clinical presentation in acute care settings.
Nurses must validate the patient's symptoms as real and distressing, even if a clear organic cause isn't found. Dismissing their complaints can damage the therapeutic relationship and lead to 'doctor shopping'.
Management focuses on building a strong, trusting relationship with a consistent healthcare provider, scheduling regular, brief appointments, and shifting the focus from finding a cure to managing symptoms and improving function.
Teaching stress-management techniques, such as relaxation exercises and mindfulness, is a key nursing intervention to help patients cope with the underlying psychological distress.

How to Approach the Question

First, identify all the patient's symptoms listed in the scenario: anxiety, headache, weakness, diarrhoea, and constipation.
Next, note the context or cause provided for these symptoms: stress, trauma, and overthinking. This establishes a strong psychological link.
Observe that the symptoms affect multiple body systems: neurological (headache), musculoskeletal/general (weakness), and gastrointestinal (diarrhoea, constipation).
Evaluate each option. Eliminate Irritable Bowel Syndrome because it's limited to the GI system. Eliminate Conversion Disorder as it involves specific neurological deficits. Eliminate Factitious Disorder as there's no mention of intentional deception.
Conclude that Somatisation Disorder is the only option that accounts for multiple, medically unexplained physical symptoms across various body systems, driven by psychological distress.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of somatoform and related disorders based on clinical presentation.
Stem keywords: anxiety, headache, stress, physically weak, trauma, diarrhoea, constipation, overthinking
Lead-in keywords: diagnosis
Clinical cues: The explicit link between physical symptoms (headache, GI issues) and psychological triggers (stress, overthinking) is the most significant clue.

Question ID

Q6u134Lf7TA0R3GYJcm0qd

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 1222-1224

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1448-1450

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7353-7355

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