A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities. The various medical examinations have ruled out any medical illness. Which of the following is most likely to be the case?
According to ICD-10 the criteria for diagnosing Somatization Disorder (F45.0) are: A. History of multiple physical symptoms, which begins before age 30, persists for several years, and compels seeking medical attention or causes significant impairment socially, occupationally, or in other important areas of the individual's activity. B. All of the following criteria must be met, and each symptom can occur at any time during the disturbance: 1. Four painful symptoms: history of pain related to at least four areas of the body or four functions (e.g., head, abdomen, back, joints, extremities, chest, rectum; during menstruation, sexual intercourse, or urination). Two gastrointestinal symptoms: history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting [not during pregnancy], diarrhea, or intolerance to different foods). 3. A sexual symptom: history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual leakage, vomiting during pregnancy). 4. A pseudoneurological symptom: History of at least one symptom or deficit suggestive of a neurological disorder not limited to pain (conversion symptoms of the type of impaired psychomotor coordination or balance, localized muscle paralysis or weakness, difficulty swallowing, lump-in-throat sensation, aphonia, urinary retention, hallucinations, loss of tactile and painful sensation, diplopia, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting). C. Either of the following two characteristics: 1. Upon adequate examination, none of the symptoms in Criterion B can be explained by the presence of a known medical illness or by the direct effects of a substance (e.g., drugs or medication). 2. If a medical illness is present, the physical symptoms or social or occupational impairment are excessive compared to what would be expected from the history, physical examination, or laboratory findings. D. The symptoms are not intentionally produced and are not simulated (unlike in factitious disorder and simulation). Everything fits with what is described in the statement. Conversive or dissociative disorder is ruled out because these are usually related to psychological factors, associated with the symptom or deficit (not deliberate). The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement. Neither would it be a hypochondriacal disorder because this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms. But it does not involve physical signs or symptoms.
Conversive disorder.
Hypochondriac disorder.
Somatization disorder.
Dissociative disorder.
Conversive or dissociative disorder is ruled out because these are usually related to psychological factors, associated with the symptom or deficit (not deliberate). The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement.
Neither would it be a hypochondriacal disorder because this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms. But it does not involve physical signs or symptoms.
Conversive or dissociative disorder is ruled out because these are usually related to psychological factors, associated with the symptom or deficit (not deliberate). The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement.