A
Below is a concise A4-friendly exam table.
Biopsychosocial Formulation – M (15 years)
| Domain | Key Points |
|---|---|
| Biological | • 3-year history of widespread musculoskeletal pain and fatigue •Generalised joint hypermobility; rheumatology work-up negative (no inflammatory disease) •Recurrent focal chest/rib pain with dizziness; poor response to simple analgesia • Multiple recurrent unexplained physical symptoms (abdominal pain, haemoptysis, palpitations, visual loss, seizure-like episode) • Functional neurological symptoms (functional visual loss resolved; likely non-epileptic seizure) • Poor sleep contributing to pain amplification and fatigue • Family history of chronic pain (mother with fibromyalgia) and sudden unexplained death in uncle A |
| Psychological | • Significant anxiety and panic attacks → avoidance and housebound behaviour • Intrusive critical internal voice with derogatory content, worse at night • Low mood, hopelessness, and reduced future orientation (GCSEs, school) • History of bullying, school exclusion, and academic difficulties • Possible neurodevelopmental traits (dyslexia, attention/sensory difficulties) • Central sensitisation and functional overlay contributing to symptom burden A |
| Social | • Not attended school for 8 months; repeated school changes and ongoing attendance pressure • Significant bullying with police involvement • Strong attachment to mother; mother highly anxious about missed diagnosis • Father unemployed due to mental health difficulties; family stressors • Older brother recently left for university; loss and altered family dynamics • Limited face-to-face peer contact; social withdrawal • Recent bereavement (uncle’s sudden death) temporally linked to symptom escalation A |
| Perpetuating / Protective | Perpetuating: • High health anxiety within family and repeated medical investigations • School avoidance, deconditioning, poor sleep • Maternal chronic pain and reinforcing protective behaviours • Ongoing diagnostic uncertainty and fear of serious illness Protective: • Previous resolution of functional symptoms with appropriate explanation • Maintained peer relationships • Engagement with healthcare services • Potential benefit from MDT input (paediatrics, CAMHS, physiotherapy, school reintegration) |
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