What do think the diagnostic is?

Michelle Larson is a 46 year old housewife referred by her husband’s psychiatrist for consultation. In the course of discussing certain marital conflicts that he was having with his wife, the husband had described “attacks” of dizziness that his wife experienced that left her quite incapacitated.

In consultation, the wife described being overcome with feelings of extreme dizziness, accompanied by slight nausea, four or five nights a week. During these attacks, the room around her would take on a “shimmering” appearance, and she would have the feeling that she was “floating” and unable to keep her balance. Inexplicably, the attacks almost always occurred at about 4:00 pm. She usually had to lie down on a couch and often did not feel better until 7:00 pm or 8:00 pm. After recovering, she generally spent the rest of the evening watching TV; more often than not, she would fall asleep in the living room, not going to bed in the bedroom until 2:00 am or 3:00 am.

Michelle had been pronounced physically fit by her internist, a neurologist, and an ear-nose-throat specialist on more than one occasion. Hypoglycemia had been ruled out by glucose tolerance tests.

When asked about her marriage, Michelle described her husband as a tyrant, frequently demanding and verbally abusive of her and their four children. She admitted that she dreaded his arrival home from work each day, knowing that he would comment that the house was a mess and the dinner, if prepared, not to his liking. Recently, since the onset of her attacks, when she was unable to make dinner he and the four kids would go to McDonald’s or the local pizza parlor. After that, he would settle in to watch a ball game on TV in the bedroom, and their conversation was minimal. In spite of their troubles, Michelle claimed that she loved and needed her husband very much.



I know she has Vertigo. I think it's Somatization Disorder.



What do you think and please explain why!

Thank you!!What do think the diagnostic is?
Take a look in your DSM IV-TR I believe she fills the criteria for anxiety disorder. Vertigo is an actual "sickness" her MD would have made the Dx. She is obviously wanting to avoid being in the presence of her husband so she more likely than not is also being abused (emotionally, psychologically, physically or all of them) by him so her love for him would tell me she may suffer from "battered wife's sindrome". In general somatization disorder sounds right but a differential Dx is needed in the case I believe.

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