A nurse is caring for a client in an outpatient clinic. A nurse is collecting data on a client who has been coming to an outpatient clinic for the last 6 months. The nurse should identify which of the following findings as manifestations of somatic symptom disorder? (Select all that apply.)

A. Anxiety is a frequent manifestation of somatic symptom disorder. Clients often experience excessive worry about physical symptoms, fearing that they indicate serious illness. This heightened anxiety can intensify the perception of physical discomfort and lead to repeated healthcare visits, frequent reassurance-seeking, and difficulty functioning in daily life. B. Gastrointestinal distress is a common physical complaint among clients with somatic symptom disorder. Symptoms can include nausea, abdominal pain, bloating, or diarrhea. These symptoms are real to the client, though medical evaluation may not identify a sufficient organic cause. The persistence and severity of these complaints distinguish them from typical minor gastrointestinal upset. C. Pain is one of the most prevalent manifestations of somatic symptom disorder. Clients may report chronic pain in the back, joints, head, or other body areas. The pain is not intentionally produced or feigned, but the intensity often exceeds what would be expected from identifiable medical conditions. This symptom can significantly impair social, occupational, and personal functioning. D. Bipolar disorder is a separate psychiatric condition characterized by alternating episodes of mania/hypomania and depression. While clients with somatic symptom disorder may have comorbid mood disorders, bipolar disorder is not a manifestation of the somatic symptom disorder itself. E. Fixation on health is a defining feature of somatic symptom disorder. Clients are often excessively preoccupied with the belief that their physical symptoms indicate serious illness. This preoccupation may lead to frequent doctor visits, repeated diagnostic tests, and high levels of health-related anxiety. It can also result in maladaptive behaviors such as avoiding activities for fear of exacerbating symptoms. F. Depression may coexist with somatic symptom disorder, but it is considered a comorbid condition rather than a core manifestation. Depression contributes to overall functional impairment but does not define the disorder. G. Localized amnesia is a symptom associated with dissociative disorders, not somatic symptom disorder. Memory loss related to traumatic events is a feature of dissociation rather than excessive concern about physical symptoms.