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Somatic symptom disorder — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Somatic symptom disorderUSMLE Step 3

A 46-year-old woman has disabling abdominal pain on most days for 18 months despite an appropriate negative evaluation. She devotes several hours daily to checking the pain, repeatedly seeks additional testing, and has stopped working because of her health concerns. What is the most likely diagnosis?

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Correct answer: A — Somatic symptom disorder with predominant pain

The best answer is “Somatic symptom disorder with predominant pain”. Her persistent, genuinely experienced pain is accompanied by disproportionate health anxiety, checking, and functional impairment. Illness anxiety disorder usually has minimal somatic symptoms, whereas factitious disorder requires evidence of intentional falsification and somatic delusions are fixed rather than characterized by this symptom-focused behavioral syndrome. Somatic symptom disorder requires distressing or functionally disruptive physical symptoms plus excessive thoughts, feelings, or behaviors; the symptoms are experienced rather than intentionally falsified.

Reference: American Psychiatric Association: What Is Somatic Symptom Disorder?: https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder