Pain psychiatry and somatic symptom disorders

Meet the patient

A 52-year-old woman has been admitted under the physicians for the fourth time this year. Each admission: chest pain, abdominal pain, dizziness, normal scans, and a discharge letter that reads medically unexplained — consider psychiatry. She arrives angry, clutching a folder of results, and tells you the last registrar said it was "all in her head."[4][24]

She takes oxycodone 40 mg a day, diazepam 10 mg at night, and has stopped working. Her PHQ-15 is high, her mood is low, and she has not slept properly in months.[4][20]

Two questions decide whether she gets better or returns a fifth time. Has anyone given her a positive explanation that doesn't call her a liar? And what is the function she has lost — and could regain? Everything below serves those two questions at consultant depth.[6][24]

References24Show ledgerHide ledger

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