Early-Onset Somatic Delusional Presentation: A Case Report and Two-Decade Comparative Synthesis

Abstract

Objective: Somatic-type delusional disorder is characterized by fixed false beliefs related to bodily changes or illness. This report describes an unusual early-onset case associated with significant functional decline and compares its features with previously published cases.

Method: Clinical information was collected through psychiatric assessment, family interviews, physical and neurological examinations, laboratory investigations, and six months of follow-up. A narrative review of relevant English-language case reports published between 2003 and 2025 was also undertaken.

Results: A 22-year-old woman developed a persistent belief that self-inflicted cuts on her feet had permanently altered her joints and skin. Despite repeated reassurance and normal medical findings, she remained convinced of the perceived deformity. The condition was associated with depressed mood, social isolation, poor self-care, reduced food intake, and academic impairment. Investigations did not identify an underlying medical cause. Treatment with olanzapine, psychoeducation, supportive psychotherapy, and family counselling resulted in gradual improvement. During follow-up, delusional conviction decreased substantially, accompanied by better self-care, social interaction, and academic functioning. Review of the literature indicated that severe impairment and early onset are relatively uncommon in somatic-type delusional disorder.

Conclusion: Early-onset somatic delusions can lead to marked psychosocial dysfunction and may differ from the traditionally described pattern of preserved functioning. Comprehensive assessment, ongoing diagnostic review, and combined pharmacological and psychosocial interventions are important for achieving favorable outcomes.