Dr. Jarmon is Attending Physician, Garnet Health Medical Center, Middletown, New York. Dr. Sullivan is Attending Physician, Garnet Health Medical Center, Middletown, New York. Dr. Vieux is Behavioral Health Chairperson and Director of Psychiatry Residency Program, Garnet Health Medical Center, Middletown, New York. Ms. Boyajian is a Licensed Mental Health Counselor, Garnet Health Medical Center, Middletown, New York.
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
After being diagnosed with a rare gastrointestinal disorder, Ms. S, age 16, has abdominal pain. She’s anxious, depressed, and overly worried about her prognosis. How do you help her?
Although Ms. S appeared thin, her BMI was within normal range. She added that she likes food and enjoyed eating, but that her medical condition made it too painful. Lastly, Ms. S denied a history of binging or purging.
Somatic symptom disorder.Table 11 outlines the DSM-5 criteria for somatic symptom disorder. A diagnosis of somatic symptom disorder requires ≥1 somatic symptoms that cause enough distress to significantly disrupt daily functioning. Furthermore, the patient is characteristically preoccupied with excessive thoughts, feelings, or behaviors as they relate to the health concern, manifested by at least 1 of the following: disproportionate and constant thoughts about the seriousness of the somatic symptom; continuous high anxiety with regard to health or somatic symptoms; and excessive time and energy spent worrying about these somatic symptoms or “health concerns.”1,2
Factitious disorder imposed on self. An individual with FDIS chronically stimulates, induces, or aggravates illnesses to gain the status of being a patient.
Factitious disorder imposed on anotheris the deliberate feigning or production of symptoms in another individual who is under the perpetrator’s supervision.1Table 23 lists clinical indicators that raise suspicion for FDIA.
Before a diagnosis of somatic symptom disorder, FDIS, or FDIA could be established or ruled out, it was imperative to gather collateral information from other clinicians involved in Ms. S’s care. Ms. S and her mother had sought out help from a pediatric surgeon, a pediatric gastroenterologist, a pediatrician, and a psychotherapist.
