Desta Ayo is a 42 year old woman, on disability pension and married to a disabled man. She was brought to the hospital by ambulance after she called 911 to report she was dying. After running a few tests, the ER physician could not find anything wrong with her. He referred her to psychiatry because the problem was obviously "all in her head." On interview, Desta sits motionless in the chair, opening her eyes and speaking with dramatic effort. She believes she is again suffering with another kidney infection, like the one that almost killed her 10 years ago. She describes "passing out" almost every day for the last 2 weeks, feeling too weak to walk, and experiencing crippling back pain. She denies anxiety and depression but continues to take paroxetine for chronic pain and Trazodone for sleep. She says she has arthritis throughout her back, frequent migraines, temperomandibular joint pain, chronic fatigue, and recurrent sinusitis that eats away at her nasal bones. She also reports a history of gynaecological problems since age 22, with breast cyst and ovarian cyst surgery, endometriosis, and uterine fibroids. She reports an early childhood history of sexual and physical abuse. She remembers her mother as an alcoholic, a distant and cruel woman. Inquiries about current stress in her life reveal major financial problems and an argument with her mother on the phone 2 weeks ago. She says that she doesn't think her mother will ever talk to her again.