Rose Smith's Disease - Case Study Example

Like Rose, individuals with somatoform disorders find it difficult to accept the underlying psychological cause of their distress and, perhaps, this resistance transforms emotional distress into physical pain, allowing them to worry about something concrete (Chu, 2011). Additionally, the somatic symptom may be the primary means of communicating emotional needs (Varcarolis, 2012) and may, indeed, be Rose’s way of using it as an unconscious expression of grief and sadness. While the new DSM (5th ed.

; DSM–5; [APA], 2013) eliminates the overlap across somatoform disorders by changing the criteria, the 4th edition (4th ed., text rev.; DSM–IV–TR; APA, 2000) makes it difficult to clarify the boundaries between subtypes. Factitious Disorder, Malingering (conscious feigning) and Conversion Disorder (unconscious feigning) can be ruled out, as there is no reason to believe that Rose Smith would have had anything obvious to gain from feigning or from assuming the sick role and because conversion symptoms are, generally, short in duration.

Substance etiology can be ruled out as well. Although it is unclear whether Dr. Stewart identified an actual lactase enzyme deficiency or diagnosed her based on her subjective symptoms, Rose’s lactose intolerance diagnosis cannot be fully dismissed. However, there is a clear distinction between the severity of her symptoms and typical lactose intolerance symptoms—the latter cannot fully explain her condition. Next we can determine which among the mental disorders presented in DSM-IV-TR best explain Rose’s symptomology.

Since pain is the cardinal focus of clinical attention and she has a medical condition that does not fully explain her physical complaints, Rose meets the criteria for Pain Disorder Associated with Psychological Factors. Nonetheless, her intense preoccupation with the idea of suffering from a serious disease may equally be indicative of Hypochondriasis. If we are to assume that her intense preoccupation is based on her misinterpretation of physical symptoms (A), then Rose meets all criteria for Hypochondriasis (300.7). After a DSM-IV multiaxial evaluation, the final assessment is: Axis I: 307.

89 Pain Disorder Associated with Psychological Factors (Chronic) or 300.7 Hypochondriasis (With Poor Insight). Axis II: None identified. Axis III: 271.3 Disaccharide malabsorption (Lactose intolerance). Axis IV: Job loss; Break-up with partner. Axis V: GAF = 50 (serious impairment in occupational and social functioning). Differential Diagnosis: Because Rose’s case does not meet the criteria for Somatization Disorder, this diagnosis can be easily ruled out. However, she meets the criteria for Undifferentiated Somatoform Disorder (300.82) but her overall condition might be better accounted for by either Pain Disorder or Hypochondriasis.

Symptoms of pain can be associated aspects of Depressive or Anxiety Disorders but Pain Disorder should be considered as a diagnosis if the pain becomes an independent/central aspect of clinical attention leading to obvious impairment and distress, as seems to be Rose’s case. Complaints about pain occur frequently in individuals with Conversion Disorder, but Conversion Disorder is not limited to symptoms of physical pain. If we are to think that the primary role in the exacerbation, severity and onset of Rose’s symptoms was played by psychological factors, and that her lactose intoleran