A 27-Year-Old Man Comes to the Emergency Department with His

A 27-year-old man comes to the emergency department with his wife because of a 3-day history of severe abdominal pain. The symptoms began after the patient woke up one morning. He is otherwise healthy. He works as a waiter and says that he feels exhausted from working several night shifts per week. He adds that he "can barely keep his eyes open" when looking after their daughter the next day. Since the onset of the pain, he has been unable to work and is fully dependent on his wife, who took on an extra shift to make enough money to pay their monthly bills. The patient appears relaxed but only allows himself to be examined after his wife convinces him. His vital signs are within normal limits. On physical examination, heart and lung sounds are normal.  Abdomen is soft and nondistended with normoactive bowel sounds.  The patient grimaces and moans in pain throughout the evaluation.  .  Laboratory evaluation and abdominal CT scan show no abnormalities.  After hearing the results, the patient asks for a note to excuse him from work so that he can recover at home for a few days.  Which of the following additional features is most likely to be present in this patient?

A) Chronic feelings of helplessness
B) Excessive anxiety about unexplained physical symptoms
C) Preoccupation with having a serious illness
D) Recurrent suicidal gestures or attempts
E) Refusal of invasive medical procedures

Correct Answer:

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