Making a Differential DiagnosisUnderstanding differential diagnosis is critical for making a proper diagnosis. The DSM-5 has provided great tools for clarifying the most accurate diagnoses based on symptoms. For this discussion, read through the Vignette of Richard, who meets the criteria of Somatic Symptom Disorder. After reading the vignette, open the Decision Tree for Somatic Complaints or Illness or Appearance Anxiety in Chapter 3 of DSM-5 Handbook of Differential Diagnosis (linked in the Resources). Follow the steps of the decision tree to find your way to the diagnosis of Somatic Symptom Disorder. Utilize the option to “View Large” for each decision tree (ignore downloading the PowerPoint). Address the following using headings to match content in each bullet point: What was most and least helpful about using the decision tree? Select one of the assessments covered in the assigned reading by Hamilton and Carr (2016), and describe how it would provide additional information that would be relevant to understanding Richard from a systemic or cultural perspective Reference: American Psychiatric Association. (2020) Chapter 2. Differential Diagnosis by the Trees. Retrieved from https://doi Hamilton, E., & Carr, A (2016). Systematic review of self-report family assessment measures. family Process, 55(1), 16-30 First, M. B. (2014). DSM-5 Handbook of Differential Diagnosis (5th ed) . Washington, D C: American Psychiatric Association Publishing Differential Diagnosis by the Trees DSM Library Decision Tree for Somatic Complaints or Illness/Appearance Anxiety When a patient presents with distressing somatic complaints, the focus of the differential diagnosis is usually on which general medical condition best explains the somatic complaints. However, when the somatic complaints are accompanied by abnormal thoughts, feelings, and behaviors, the presence of a Somatic Symptom Disorder or other mental disorder should be considered. Physical complaints that are feigned by the patient warrant either the mental disorder diagnosis Factitious Disorder or the nondisordered condition known as Malingering. The differentiation between these two conditions depends on a consideration of the context in which the somatic symptoms developed. If the feigning of the symptoms occurs in the absence of obvious external rewards, the diagnosis is Factitious Disorder, whereas feigning in settings in which the presence of the somatic symptoms provides an obvious financial or other benefit to the patient suggests Malingering. Somatic complaints can occur as a manifestation of a wide variety of psychiatric conditions. Substance Intoxication or Substance Withdrawal is typically manifested as a characteristic syndrome of somatic and behavioral symptoms. States of high anxiety are typically associated with a variety of somatic complaints. Consequently, somatic complaints are commonly associated with many of the Anxiety Disorders. For some Anxiety Disorders, such as Panic Disorder and Generalized Anxiety Disorder, the distressing somatic complaints characteristic of these disorders may be the reason for the patient to seek treatment. In other cases, the somatic complaints are related to the manifestations of a psychotic disorder (e.g., somatic delusions) or an Obsessive-Compulsive and Related Disorder, such as the preoccupation with an imagined physical defect in Body Dysmorphic Disorder. When the somatic complaints themselves are the patient’s central focus, a diagnosis of one of the DSM-5 Somatic Symptom and Related Disorders might be most appropriate. Patients presenting with neurological symptoms such as paralysis or seizures which, upon examination and laboratory investigation, do not conform to a pattern characteristic of a known neurological or other medical condition, can be diagnosed with Conversion Disorder (Functional Neurological Symptom Disorder). Other types of somatic complaints, when accompanied by disproportionate thoughts about the seriousness of the illness, persistently high levels of anxiety about health or about symptoms, or the devotion of excessive time and energy to symptoms or health concerns, may warrant a diagnosis of Somatic Symptom Disorder. In contrast to the DSM-IV Somatoform Disorder diagnoses in which the somatic complaints were by definition medically unexplained, a diagnosis of Somatic Symptom Disorder in DSM-5 can be given to patients with a bona fide medical illness. The DSM-5 diagnosis depends on the presence of cognitions, feelings, and behaviors that are, in the clinician’s judgment, “excessive” given the nature of the general medical condition. To avoid pathologizing appropriate reactions to serious or disabling general medical conditions, this diagnosis should be used very cautiously in medically ill individuals, being reserved only for cases in which the person’s reactions to having the medical illness are clearly extreme and maladaptive.