Dunphy Louise, Penna Marta, El-Kafsi Jihene
Department of General Surgery, Wexham Park Hospital, Slough, UK
Department of General Surgery, Wexham Park Hospital, Slough, UK.
BMJ Case Rep. 2019 Nov 25;12(11):e231550. doi: 10.1136/bcr-2019-231550.
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's 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.
躯体症状障碍（SSD）是在2013年《精神疾病诊断与统计手册》第五版（DSM-5）出版时引入的一种诊断。它取消了躯体化障碍、未分化躯体形式障碍、疑病症和疼痛障碍的诊断；以前被诊断为这些疾病的大多数患者现在在DSM-5中被诊断为SSD。这种疾病的主要特征是患者对未发现生物学病因的躯体症状感到担忧。需要进行精神科评估以排除共病的精神疾病。未能识别这种疾病可能会导致粗心的内科医生或外科医生进行调查或诊断程序，从而可能导致医源性并发症。它还给医疗服务带来了巨大的经济负担。患有非特异性腹痛的患者持续使用医疗服务，症状预后较差。已证实的治疗方法包括认知行为疗法、正念疗法以及使用选择性5-羟色胺再摄取抑制剂或三环类抗抑郁药的药物治疗。作者描述了一名31岁女性的病例，她患有情绪不稳定型人格障碍和共病疾病，因左侧腹部和腿部疼痛3周就诊于急诊科。尽管进行了大量检查，但未发现她疼痛的器质性原因。多学科团队包括外科医生、内科医生、神经科医生和精神科医生对她进行了会诊。随后做出了躯体形式症状障碍的诊断。由于SSD患者会前往全科医疗和急诊科而非精神科就诊，该病例警示我们有必要进一步提高对这种疾病的正确认识。
