Persistent Somatic Pain Masking Psychiatric Distress in Borderline Personality Disorder and Major Depression: A Case Report

Abstract

Somatic pain without clear medical explanation is frequently encountered in clinical settings and may reflect underlying psychiatric conditions. This case describes an 18-year-old female with a history of borderline personality disorder and major depressive disorder who presented to the emergency department with acute headache accompanied by nausea, vomiting, and limb weakness. Neurological evaluation, imaging, and laboratory testing were unremarkable, and analgesic therapy produced minimal symptom relief. Persistent severe pain and repeated requests for medical reassurance contrasted with incongruent clinical observations. Psychiatric assessment revealed significant emotional distress associated with an interpersonal conflict. After transfer to the psychiatric ward, intensive psychotherapy incorporating supportive and mindfulness-based approaches resulted in gradual symptom improvement without changes in analgesic medication. This case highlights the importance of a psychiatric perspective in managing persistent somatic complaints and supports a multidisciplinary approach when symptoms exceed expected clinical findings or fail to respond to standard medical treatment.