[Diagnostic dilemmas in persistent nutritional complaints and the need for integrated care]

In patients with longstanding nutritional problems and gastrointestinal symptoms, underweight or with significant weight loss, mostly without an identifiable somatic cause, a diagnostic dilemma arises. There is considerable symptomatic overlap between anorexia nervosa (AN), avoidant/restrictive food intake disorder (ARFID), and somatic symptom disorder (SSD) in such cases, which can lead to divergent clinical interpretations, delayed interventions, and lack of therapeutical direction. We describe a 49-year-old patient who had been treated for several years by gastroenterologists for nausea, vomiting, and weight loss. Extensive diagnostics revealed no abnormalities, and pharmacotherapy had little effect. After several second opinions, both somatic and psychiatric, her symptoms were classified as SSS, and the patient began psychotherapeutic treatment. Although the DSM-5 allows for classification, there is a lack of consensus regarding the nature of this clinical presentation and appropriate treatment strategies. We identify factors that may help differentiate between the above-mentioned classifications, though further research into underlying mechanisms remains essential. Current healthcare structures often fail to meet the complex needs of these patients. Moreover, the somatic features of this condition lead to exclusion from treatment programs. We advocate for cross-domain diagnostics and integrated care, in which biological, psychological and social aspects are regarded as equally essential components.