Rosh Psychiatry Board Practice Exam

What is the most likely diagnosis for a man who presents with complaints of lower back pain without signs of trauma or inflammation?

1. Malingering

2. Munchausen by proxy

3. Munchausen syndrome

4. Somatic symptom disorder

The correct answer is: Malingering

The scenario describes a man experiencing lower back pain absent any evidence of trauma or inflammation, which opens the door to various interpretations of his condition. The most fitting diagnosis among the provided options is somatic symptom disorder. Somatic symptom disorder is characterized by an intense focus on physical symptoms (in this case, lower back pain) that causes significant distress or impairment, even in the absence of a clear medical explanation. The individual's complaints may not correlate with any identifiable medical issue, but the distress and dysfunction resulting from these symptoms are very real to the person. This disorder emphasizes the psychological aspects of physical symptoms. Malingering typically involves intentional deception for external gain, such as avoiding work or obtaining medication. In this case, the question does not present any evidence of intentional deceit or motivation for secondary gain, making somatic symptom disorder a more appropriate diagnosis. Munchausen syndrome and Munchausen by proxy involve fabricated or induced symptoms for the purpose of gaining attention, which does not align with the information given about the man’s condition. The diagnosis hinges on the presence of significant distress and impairment linked to the somatic complaint without a medical basis, rather than a deliberate fabrication of symptoms.