Somatic Symptom and Related Disorders
6 cases on somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder pharmacotherapy — choose a case below to open its full multi-voice debate.
A single patient with fourteen months of unexplained multisystem symptoms and a normal depression screen. The disagreement isn't whether an antidepressant might help — it's whether prescribing one requires first finding a depression to treat, and if not, which drug class actually fits what she has.
A single patient whose illness anxiety looks phenomenologically close to OCD — checking, reassurance-seeking, intrusive health fears — but whose own hypersensitivity to bodily sensation makes the OCD playbook's aggressive dosing a genuinely double-edged recommendation.
Two patients with the same diagnosis and genuinely comparable trial evidence for either modality. The disagreement isn't about which treatment works — both do — it's about whether access and severity are ever reasons to abandon a philosophy of psychotherapy first.
A single patient with video-EEG-confirmed nonepileptic seizures and a depression screen that crossed threshold three months after her father's death. The disagreement isn't about the seizures — no voice thinks a pill treats those — it's about whether her PHQ-9 describes grief or a second, independently treatable condition.
A single patient with functional right-arm weakness and longstanding, recently worsened generalized anxiety. The disagreement isn't whether to treat her anxiety — everyone agrees she should — it's whether doing so is honestly expected to improve her arm, or only sold to her that way.
A single patient whose third unexplained hypoglycemic hospitalization this year was traced to covert insulin use. No voice here thinks a drug treats deception itself — the disagreement is whether that leaves any legitimate role for pharmacotherapy at all.