Somatic symptom disorder — structured clinical viva

You are the psychiatry registrar on a consultation-liaison list. A 45-year-old man with known multi-symptom SSD is admitted after his fifth 'negative' medical work-up this year. The medical team wants you to 'tell him it is psychiatric' and stop further tests. He is furious, believes something is being missed, scores high on PHQ-15, has moderate depression, and takes escalating night-time diazepam plus PRN codeine. Discuss how you will engage him, defend the SSD formulation without dualism, set a collaborative investigation plan, outline stepped psychological and pharmacological care, and address iatrogenic harm.