{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:45:22Z","timestamp":1787913922672,"version":"build-2784847793"},"reference-count":16,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,10,1]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Somatic symptom disorder (SSD) is a diagnosis that was introduced with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. It eliminated the diagnoses of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder; most of the patients who previously received these diagnoses are now diagnosed in DSM-5 with SSD. The main feature of this disorder is a patient\u2019s concern with physical symptoms for which no biological cause is found. It requires psychiatric assessment to exclude comorbid psychiatric disease. Failure to recognise this disorder may lead the unwary physician or surgeon to embark on investigations or diagnostic procedures which may result in iatrogenic complications. It also poses a significant financial burden on the healthcare service. Patients with non-specific abdominal pain have a poor symptomatic prognosis with continuing use of medical services. Proven treatments include cognitive behavioural therapy, mindfulness therapy and pharmacological treatment using selective serotonin reuptake inhibitors or tricyclic antidepressants. The authors describe the case of a 31-year-old woman with an emotionally unstable personality disorder and comorbid disease presenting to the emergency department with a 3-week history of left-sided abdominal and leg pain. Despite a plethora of investigations, no organic cause for her pain was found. She was reviewed by the multidisciplinary team including surgeons, physicians, neurologists and psychiatrists. A diagnosis of somatoform symptom disorder was subsequently rendered. As patients with SSD will present to general practice and the emergency department rather than psychiatric settings, this case provides a cautionary reminder of furthering the need for appropriate recognition of this condition.<\/jats:p>","DOI":"10.1136\/bcr-2019-231550","type":"journal-article","created":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T04:45:21Z","timestamp":1574743521000},"page":"e231550","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Somatic symptom disorder: a diagnostic dilemma"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-415X","authenticated-orcid":false,"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Department of General Surgery, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Penna","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihene","family":"EL-Kafsi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,11,25]]},"reference":[{"key":"2025082702590752000_12.11.e231550.1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th edn [DSM-5]. Arlington: American Psychiatric Association, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025082702590752000_12.11.e231550.2","unstructured":"Bass C . Introduction. In: Bass CM , ed. Somatization \u2013 physical symptoms and psychological illness. Oxford: Blackwell Scientific, 1990."},{"key":"2025082702590752000_12.11.e231550.3","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Somatic Symptoms and related disorders. In: Diagnostic and statistical manual of mental disorders. 5th edn. Airlington, VA: American Psychiatric Publishing, 2013: 318\u201321.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025082702590752000_12.11.e231550.4","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC, 2013: 311.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025082702590752000_12.11.e231550.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.322.7289.767","article-title":"Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study","volume":"322","author":"Reid","year":"2001","journal-title":"BMJ"},{"key":"2025082702590752000_12.11.e231550.6","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.184.6.470"},{"key":"2025082702590752000_12.11.e231550.7","unstructured":"Gross AF , Lokko HN , Huffman JC , et al . Chapter 229: Approach to the Patient with Multiple Unexplained Somatic Symptoms. In: Principles and practice of hospital medicine. 2nd edn, 2017."},{"key":"2025082702590752000_12.11.e231550.8","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-199003000-00002"},{"key":"2025082702590752000_12.11.e231550.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(02)00686-7"},{"key":"2025082702590752000_12.11.e231550.10","doi-asserted-by":"crossref","unstructured":"Poloni N , Ielmini M , Caselli I , et al . Medically unexplained physical symptoms in hospitalized patients: a 9-year retrospective observational study. Frontiers in Psychiatry 2018;9.doi:10.3389\/fpsyt.2018.00626","DOI":"10.3389\/fpsyt.2018.00626"},{"key":"2025082702590752000_12.11.e231550.11","doi-asserted-by":"crossref","unstructured":"Minute M , Cozzi G , Barbi E . An adolescent with disabling abdominal pain. BMJ 2016;335.doi:10.1136\/bmj.i6101","DOI":"10.1136\/bmj.i6101"},{"key":"2025082702590752000_12.11.e231550.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60159-7"},{"key":"2025082702590752000_12.11.e231550.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.11.1360"},{"key":"2025082702590752000_12.11.e231550.14","doi-asserted-by":"crossref","unstructured":"van Dessel N , den Boeft M , van der Wouden JC , et al . Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev 2014:CD011142.doi:10.1002\/14651858.CD011142.pub2","DOI":"10.1002\/14651858.CD011142"},{"key":"2025082702590752000_12.11.e231550.15","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31816aa0ee"},{"key":"2025082702590752000_12.11.e231550.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2010.09.001"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231550","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:59:15Z","timestamp":1756288755000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,25]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bcr-2019-231550"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231550","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}