Differential Diagnosis for the 28-year-old Man

Given the scenario, the focus is on determining a psychiatric diagnosis based on the information provided, which includes severe abdominal pain, incarceration, and an impending court hearing, alongside normal medical test results.

• Single most likely diagnosis

  • Factitious Disorder: This condition is characterized by the intentional production or feigning of physical or psychological symptoms, primarily motivated by the desire to assume the sick role. The patient's severe abdominal pain without a clear medical cause, coupled with the context of his incarceration and upcoming court hearing, suggests he might be fabricating his symptoms to potentially avoid his court appearance or gain attention and sympathy.

• Other Likely diagnoses

  • Malingering: This involves the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, obtaining financial compensation, or in this case, possibly avoiding a court hearing. The timing of his symptoms and the context of his legal situation make this a plausible consideration.
  • Anxiety Disorder: The stress of an impending court hearing could manifest as somatic symptoms, including abdominal pain, especially if the individual has a predisposition to anxiety. However, the severity and focus of the abdominal pain might not fully align with typical presentations of anxiety disorders.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Somatoform Disorder: Although less likely given the specific context, somatoform disorders involve symptoms that cannot be explained by a medical condition, substance, or other mental disorder. The patient's symptoms could theoretically align with a somatoform disorder if they are experiencing unexplained physical symptoms due to psychological distress.
  • Psychological Factors Affecting Other Medical Conditions: If there was an underlying medical condition not yet identified, psychological factors (e.g., stress from the legal situation) could be exacerbating the condition, even if the current tests are normal.

• Rare diagnoses

  • Conversion Disorder (Functional Neurological Symptom Disorder): This involves neurological symptoms that cannot be explained by medical evaluation. While abdominal pain is not typically a symptom of conversion disorder, in rare cases, psychological distress could manifest in unusual somatic complaints.
  • Hypochondriasis (Illness Anxiety Disorder): The patient might be excessively worried about having a serious illness, based on his interpretation of bodily symptoms (abdominal pain), despite medical reassurance and lack of evidence for such an illness. However, the primary concern here seems more aligned with avoiding a legal consequence rather than a fear of illness itself.