Attached is a Lesson on somatic symptom disorders.
At the is the case study. And under the case study is the questions that need to be answered.
Case Study – Sofia
Sofia, age 51 is a physician assistant who lives a full and active life. She reported that she is generally very energetic. She spends time going shopping, eating in restaurants, visiting museums and going to the movies. She reported that she is “happy enough” with her job. She has never been married. She has one son who is 29 years old. He lives 300 miles away, and she hasn’t seen him for 1 year. He has a wife and a 9 month old daughter. Sofia has never met her granddaughter. Sofia reports that her parents are both deceased. She says she has two female siblings – twins- that are 3 years older than her. They both live about 50 miles away with their families, but she doesn’t see them very often.
Approximately 9 months ago Sofia was taking the subway home from a shopping trip when it struck a stationary train on the track ahead. Although her train was not traveling at a high speed, the impact was forceful enough to hurl the passengers from their seats and partially crush the metal cars. Sofia was thrown forward. Her left leg struck a seat jutting out in front of her wrenching her knee, and her head struck a metal pole knocking her out. When she regained consciousness she found herself among many other passengers who were also injured. She saw many people were unconscious and bleeding. She put her own hand to her forehead and realized she was also bleeding. She reported that “horrific thoughts went through her mind.” One reported thought was, “What if I bleed to death before someone comes to help?” Sofia reported that it took 30 minutes before the rescue team finally came.
When the rescue team came, they took Sofia to the hospital. It was immediately determined that Sofia did not lose a critical amount of blood. Because the ER was very busy, and because Sofia was not in critical condition, she laid on a gurney in the emergency room for 3 hours. She did not know the severity of her injuries; therefore she remained in a highly anxious state for the three hours. Sofia was given additional tests and scans and wheeled to a waiting area. In this area, she reported that she saw many nurses and doctors running, people bleeding and shouting and children crying. People were coughing and moaning with pain, and she was convinced that she was going to catch a disease on top of her injuries. Approximately 2 hours later, a doctor came to talk to Sofia. He informed her that she was very lucky. She did not suffer any broken bones or brain hemorrhage. He informed her that a nurse would come to talk with her about treatment for her head wound, but that she was well enough to be released. When she was released, it was 1am. She could not think of anyone whom she could call at 1am, so she called a cab to take her home. She reported that once home, she slept until 6pm the next day.
When she woke up the next day, Sofia called a co-worker to tell her what happened. As she told her story, she began to become very concerned that she could have been severely injured. Sofia lives alone, and the idea of not being able to take care of herself paralyzed her with fear. Her co-worker was very caring and sympathetic and offered to help, asking what she could do. Sofia reported that she felt disoriented and had difficulty answering her questions. She grew extremely tired and after talking for about 20 minutes, she couldn’t talk anymore and hung up.
Sofia stayed in her apartment for the next 3 days. On the 3rd day she attempted to see a neurologist as instructed by the ER doctor. When she walked out of her apartment, Sofia was struck by how noisy everything seemed to be. The traffic seemed unbearably loud to her, and she was tentative about crossing the street. She reported that she was still in a lot of pain from the accident. She reported that “even though I was struck in the knee and the head, every part of my body was in pain. Even my hands hurt.” Sofia said that her apprehension about crossing the street turned into fear. What if a car hit her? She also reported that she remembers becoming “extremely worried that the doctor in the ER did not do all of the tests he should have.” Despite her desire to consult the neurologist, her fear of crossing the street overtook her, and she turned around and went back home. She missed the appointment. When she got home she called a colleague. She told her that she really wanted to see the neurologist, but was still too shaken up to go alone. The colleague agreed to go with her. Sofia called the neurologist’s office and made a new appointment for one week later.
Sofia reported that during that week she did not go back to work and barely left her apartment. She ordered in food as she “lost the pleasure she used to find in going to restaurants because she was now too scared.” She slept approximately 4-5 hours per night and would often awake from nightmares about the accident.
On the day of the appointment with the neurologist, her colleague came to pick her up. They walked together to her colleague’s car. Sofia reported feeling “woozy” but she was able to get into the car. Once at the neurologist, she was given 3 tests. She was diagnosed with a mild concussion. The doctor told her she should be completely better in 4-6 weeks and that she should rest as much as possible. Sofia reported that she did not believe her concussion was mild. On the ride home she told her colleague she was going to go for another opinion.
Over the next weeks, Sofia’s symptoms did not improve. She reported having “constant dull headaches.” She reported that she worried something else was going on besides the mild concussion which should have been close to healed by then. Some nights she only got 3-4 hours of sleep because she worried. In addition, her knee throbbed and ached. She also reported that pain began to develop in her joints, her jaw and the heels of her feet.
Her fearfulness of crossing the street also did not improve. She reported that she worried about a car hitting her. Every time she heard a car horn beep, she became “unraveled.” She went back to work, and felt “okay” while she was there, but traveling to and from work was reportedly “very difficult.” She also reported that she had not been shopping, to a restaurant, to a museum or a movie since before the accident.
As the weeks passed, Sofia found the need to continuously and excessively talk about her accident. Her colleagues grew tired of listening. She also began to become extremely worried about how her chronic pain was affecting her overall health. She reported that she went to 3 more doctors for additional opinions on her health status. The last doctor she went to referred her to a therapist.
Please answer these questions with a minimum of 2 sentences for each. Make sure you answer all questions.
If you were Sofia’s psychologist, what items in this case study would you think were important to her diagnosis and treatment? Why are these important?
What do you think Sofia’s diagnosis is? Why did you choose this diagnosis? What is the differential diagnosis? Why?
