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Difficulty: MediumSomatic Symptom and Eating Disorders

Evaluate the following distinct patient presentations and pair each with the single most accurate psychiatric diagnosis.

  • A 34-year-old woman develops sudden-onset right arm paralysis immediately following a heated argument with her spouse. Neurologic examination shows preserved deep tendon reflexes and no evidence of a specific neuroanatomic lesion.Functional neurological symptom disorder
  • A 45-year-old man repeatedly visits his physician convinced he has pancreatic cancer due to occasional mild indigestion. He spends hours daily researching survival rates despite multiple negative CT scans and endoscopic evaluations.Illness anxiety disorder
  • A 28-year-old intensive care nurse is hospitalized for severe hypoglycemia. Laboratory studies show markedly elevated serum insulin levels with suppressed C-peptide and a negative sulfonylurea screen.Factitious disorder
  • A 41-year-old woman reports constant, widespread joint and abdominal pain for the past year. Repeated extensive medical workups are unremarkable, but she devotes excessive time and energy to worrying about her persistent pain.Somatic symptom disorder
  • A 22-year-old woman with a BMI of 23 kg/m223 \text{ kg/m}^2 presents with bilateral parotid gland swelling, dental enamel erosion, and laboratory findings of hypokalemic, hypochloremic metabolic alkalosis.Bulimia nervosa

Answer

L1 pairs with Functional neurological symptom disorder; L2 pairs with Illness anxiety disorder; L3 pairs with Factitious disorder; L4 pairs with Somatic symptom disorder; L5 pairs with Bulimia nervosa.
Each clinical vignette presents classic pathognomonic features that differentiate DSM-5 psychiatric disorders. Accurate diagnosis relies on distinguishing the primary clinical driver: acute neurologic deficits (Conversion), fear of disease (Illness Anxiety), distress over actual physical symptoms (Somatic Symptom), intentional deception without external reward (Factitious), or compensatory purging behaviors (Bulimia Nervosa).

Step-by-Step Solution

1
Analyze the patient with non-anatomic arm paralysis following a stressor.
Identified as a neurological symptom inconsistent with known neuroanatomy.
Directs the diagnosis to functional neurological symptom disorder (conversion disorder).
2
Analyze the patient with extreme fear of pancreatic cancer but minimal symptoms.
Identified as extreme health anxiety out of proportion to actual somatic complaints.
Directs the diagnosis to illness anxiety disorder.
3
Analyze the nurse with unexplained hypoglycemia, high insulin, and low C-peptide.
Identified as intentional induction of illness (injecting exogenous insulin) to assume the sick role.
Directs the diagnosis to factitious disorder.
4
Analyze the patient with a one-year history of widespread pain and excessive worry.
Identified as highly distressing, actual physical symptoms paired with excessive psychological focus on them.
Directs the diagnosis to somatic symptom disorder.
5
Analyze the normal-weight patient with parotid swelling and metabolic alkalosis.
Identified as classic physical signs of purging behavior.
Directs the diagnosis to bulimia nervosa.

Key Concept

Differentiation of somatic symptom and eating disorders based on the presence of physical symptoms, the patient's underlying motivation, and specific clinical exam/laboratory findings.
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Topics

Somatic Symptom and Eating Disorders

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