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    Somatoform Disorders Case Analysis

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    I need a diagnosis for the female in the case study:

    client: No one understands. It's so hard being on my own and
    taking care of myself.
    FEMALE SPEAKER: I know it must be hard. And how long has it been since your husband passed away?
    CLIENT: It's been five years. And we used to do everything together. And now--I wasn't always a good wife. I loved him. But I didn't always enjoy my wifely duties.
    I miss him. But I don't miss that. Is that OK to say? No. I'm not here to talk about that.
    FEMALE SPEAKER: Well, let's talk about why you are here. FEMALE SPEAKER: Well, I'm here because my doctor thinks that I should see a talk doctor, like you. But I've never needed one before in the past. I've always been really healthy. And now I'm like-¬
    CLIENT: I'm in pain.
    FEMALE SPEAKER: Can you tell me where it hurts?
    CLIENT SPEAKER: Everywhere. My arms, my legs, my back. I'm like--It comes
    through my chest. There's some days I can't even go to work. I can't cook or get in the bath. It's just lay in bed all day long.
    FEMALE SPEAKER: Well, chronic pain can be really agonizing.
    FEMALE SPEAKER: It's overwhelming.
    FEMALE SPEAKER: I'm really sorry. What does your doctor say?
    CLIENT SPEAKER: The doctors? What don't they say? I mean, one day it's this. One day it's that. But they can figure out what it is. And I'm just sick of the whole mess of them. I mean one doctor even told me to get on pain management. But I do not take drugs. I don't want to take drugs.
    FEMALE SPEAKER: It sounds like you're under a lot of stress.
    FEMALE SPEAKER: You had mentioned missing work and not being able to take care of yourself.
    FEMALE SPEAKER: Do you have any friends or family to help you out?
    CLIENT SPEAKER: I do. I do. Thank God. I mean she's out in the waiting room.
    If it wasn't for her, I wouldn't be able to be sitting here right now. I haven't been
    able to drive myself anywhere since the accident.
    FEMALE SPEAKER: That's really kind of her. You've had a bad stretch, haven't you?
    FEMALE SPEAKER: So what happened in the accident?
    CLIENT SPEAKER: Well, I was driving to work. And this guy just comes along
    and sideswipes me. My car hit the curve. It broke the axle. And then the guy just took off, like you know.
    FEMALE SPEAKER: Were you hurt?
    CLIENT SPEAKER: Yes, I was hurt. But the people in the ER, they didn't believe me. And they said that I didn't have any injuries. And so that they couldn't keep me. But I know what I felt. I was hurt.
    And that's why I'm suing them. Because I was hurt all over from that crash. And they did nothing to help me. Nothing. My stomach, my stomach is still in pain from that day. You wouldn't believe how nauseous I get. I throw up all the time.
    And my throat. And my throat. I had problems with my throat. But since the accident, it's been really hard to swallow. You believe me, don't you?

    I need a rationale for assigning these diagnoses on the basis of the DSM.
    Please consider the presenting symptoms of the client and any confounding factors that may influence diagnosis.
    Lastly, please describe three confounding factors that may influence client diagnosis and why. Be specific.

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    Solution Preview

    As you read through the case, the first thing to look for is the presenting theme: you will notice that in the highlighted sections of the dialogue the person is presenting with a lot of complaints about body pain and a sense that the body is injured. It is also important to note that her body pain is very generalized and is not focused on a specific area of injury but in a sense of "all over" pain.

    This theme of body pain begins to point one in the direction of a somatization disorder, where there is a distinct number of physical pain factors present that do not have a corresponding underlying cause upon medical examination. It is easy to remember to consider somatization disorder when it involved body pain if you can remember that the word "soma" in Latin means body. For the above case, since pain is also the presenting factor, you will also want to consult the DSM regarding the diagnosis of Pain Disorder. You will want to go through the case study again and determine how many of these diagnostic criteria are present vs. how many of the diagnostic criteria are present for Somatization Disorder. You will want to get out your DSM in order to have full descriptions of each of these symptoms.

    Diagnostic Criteria for Pain Disorder
    A. Pain in one or more anatomical sites is the predominant focus.
    B. The pain causes clinically significant distress or impairment in social, occupational or other important areas of function.
    C. psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
    D. The symptom or deficit is not intentionally produced or feigned.
    E. The pain is not better accounted for by a Mood, Anxiety or Psychotic Disorder

    * From American Psychiatric Association. ...

    Solution Summary

    This is an examination of a case where the presenting problem relates to differentiating between several different Somatoform disorders.