Approach To The Patient With Multiple Somatic Symptoms

Jane, a 42-year-old homemaker, presented with a persistent sensation of throat discomfort and fear of choking during eating over the past six months. She had sought multiple consultations with several primary care physicians and had undergone extensive 'full-body check-ups' - including laboratory investigations, cancer markers, radiography, nasoendoscopy and oesophagogastroduodenoscopy. The results were all unremarkable except for laryngopharyngeal reflux. She experienced some improvement in the globus sensation after she was started on proton-pump inhibitors but continued to have significant difficulty with eating. Jane said that she now required three hours to complete each meal and was only able to tolerate minced food or porridge. She had lost 8 kg since the onset of her symptoms. She was distressed and reported worsening anxiety and constant ruminations about her symptoms. She also experienced anhedonia and insomnia.