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Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D. — a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program — to help us better understand somatic symptom disorder by talking about its symptoms and treatments.

 

Dear Dr. Pat,

I am very concerned about my niece, who moved to the city where I live after college and has become part of our family here. I work in an insurance firm, where I evaluate medical claims so I know enough to know that my niece’s history is unusual.  She is 27 and now has her third job since graduating from college. The fit, the stress of the jobs and her inability to be consistent in attendance at work were all factors in each job not working out.

She is an attractive young woman with friends.  However, she seems to have low energy most of the time. She has roving complaints of a physical nature and at this point has had the following: multiple visits to emergency rooms for pelvic and abdominal pain that resulted in CT scans three times to rule out appendicitis at three different hospitals; disabling  menstrual pain causing her to miss work almost every month for a day. She could not tolerate the birth control pill or the injection of progesterone that might have helped with the menstrual pain because it caused mood swings.  She had a laparoscopy last year to “rule out” endometriosis and everything was normal. A progesterone IUD was inserted and she does have both contraception and relief of menstrual pain since the periods are almost absent with this form of contraception; she is on a gluten free and lactose free diet for vague gastrointestinal complaints and has episodic chest pain and palpitations, also leading to multiple ER visits. She has had multiple EKGs and other heart tests, including blood work for everything, all of which were negative.  Finally, she is always “tired.” She needs nine hours of sleep or just “can’t function.”

I worry about her ability to hold down a job and to maintain a relationship with this focus she has on recurring disabling symptoms. I suggested that she might want to talk to a therapist and she acted as if I did not believe that she actually had physical symptoms. She has now seen good doctors, has not been in an emergency room for almost a year because we insisted that she call one of the good doctors before going to any.

Theresa

 

Dear Theresa,

Many families and doctors have experience with unfortunate men and women who suffer from multiple symptoms that interfere with both their quality of life and their ability to function professionally and often in relationships and often no diagnosis can be found. It seems as though your niece, with your guidance, now has a team of doctors who know her baseline history so that she is no longer having radiation from “just in case” CT scans and is not spending time in emergency departments where she is seeing a new doctor each time.  

Dr. Pat

RELTED: Dr. Pat Consults: Treatment Options for Anxiety

Next Page: Dr. Riddle Responds

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  • Mickey April 18, 2016 at 1:06 pm

    I do wish this young woman would consider psychotherapy. She could explore what triggers these episodes of physical symptoms. I remember how upset my stomach used to be when I went to work. It was a stressful place but no option to look for another job. Would she be open to acupressure? Jin Shin Jyutsu has a marvelous way of shifting one’s perspective sometimes as well as relieving physical symptoms. God bless her.

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