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

Step 1: Understanding the Question:
A 41 year old woman has widespread body pain, poor sleep, poor appetite, loss of interest in work, and withdrawal from friends and family, but she specifically denies feeling sad. We need to pick the diagnosis that best fits this pattern.

Step 2: Key Concept:
Several conditions can present with physical complaints instead of, or alongside, mood complaints. Somatoform pain disorder centers on pain that cannot be fully explained by a physical cause. Somatization disorder needs many physical complaints across different body systems over years, usually starting before age 30. Major depression usually includes low mood, though it can sometimes hide behind physical symptoms, a pattern often called masked depression. Dissociative disorder involves disruption of memory, identity, or awareness, not bodily pain.

Step 3: Detailed Explanation:
The leading complaint here is pain all over the body, paired with vegetative symptoms, poor sleep, poor appetite, and loss of interest, along with social withdrawal.
She actively denies sadness, which makes a straightforward major depression label less immediate, even though sleep loss, appetite loss, and loss of interest do overlap with depressive symptoms, this overlap is exactly why this question is often debated.
Somatization disorder needs a long history of many different physical complaints across several organ systems built up over years, which is not clearly described here, this vignette reads more like a single dominant complaint of body wide pain.
Dissociative disorder does not fit at all, there is no mention of memory gaps, altered identity, or loss of awareness.
The original exam key selects somatoform pain disorder, treating the persistent, body wide, medically unexplained pain as the primary problem, with the other features, sleep, appetite, mood, seen as accompaniments rather than the core diagnosis. This exact question is known to be debated among examinees, since the vegetative symptoms and denial of sadness together also fit the classic description of depression presenting through physical symptoms, called masked depression.

Step 4: Final Answer:
Following the original paper's key, the diagnosis is somatoform pain disorder, built around widespread pain as the chief complaint, though readers should note this particular question is a recognized point of debate, with major depression, masked depression, as the commonly argued alternative.