Question

A 41 year old woman presented with a history of aches and pains all over the body and cannot sleep because of the illness, and has lost her appetite as well. She has lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. Her most likely diagnosis is

• A. Somatoform pain disorder.
• B. Major depression.
• C. Somatization disorder.
• D. Dissociative disorder.

Hint:

Widespread unexplained pain as the chief complaint points to somatoform pain disorder; note this vignette is a classically debated one.

Answer 1

The Correct Option is A

This vignette gives a woman with body wide pain, poor sleep, poor appetite, loss of interest, and social withdrawal, but she says she does not feel sad. The question wants the diagnosis that fits this picture best.

1. Somatoform pain disorder: Here pain, without a clear physical cause, is the main and persistent complaint, and the other symptoms are read as accompanying it. This is the answer given in the original key.
2. Major depression: Poor sleep, poor appetite, and loss of interest are core depressive symptoms, and denying sadness while having these features is sometimes called masked depression. Many exam takers argue for this option instead, which is why this particular question is a known point of debate.
3. Somatization disorder: This needs a long standing pattern of many physical complaints spread across different body systems, usually starting before age 30. The vignette gives one dominant complaint, body pain, without that broader multi system, multi year history, so it fits less well.
4. Dissociative disorder: This involves a break in memory, identity, or awareness of surroundings. Nothing in the vignette describes memory loss or altered identity, so this does not fit.

The case sits at the overlap between pain focused somatoform presentations and depression hiding behind physical symptoms, which is exactly why answer choices differ across sources for this question.

Let's summarize:

• Pain as the chief, persistent complaint without adequate physical explanation points toward somatoform pain disorder.
• The same vegetative symptoms could also support masked depression, making this a debated question in practice.

Following the original paper's answer key, the diagnosis here is somatoform pain disorder.