Barriers across the biopsychosocial spectrum: a case report of delayed recognition of psychosis with predominant somatic symptoms

Abstract Introduction Psychosis is a heterogeneous psychiatric disorder that may present with predominantly somatic symptoms. Such presentations are challenging to diagnose, particularly in resource-limited settings where stigma, low mental health literacy, and fragmented referral systems delay care. Case description A 33-year-old female from remote Nepal presented with a five-year history of persistent and worsening somatic complaints, fixed bodily beliefs, and marked functional decline. She consulted multiple health facilities, cross-border hospitals, and traditional healers, undergoing extensive investigations with no relief, delaying psychiatric referral, and increasing morbidity. On presentation, she exhibited persecutory and somatic delusions, somatic hallucinations, depressive cognitions, and poor insight. She was diagnosed with schizophrenia and treated with antipsychotics, nutritional rehabilitation, and family psychoeducation, resulting in notable clinical improvement. Discussion This case illustrates how biological, psychological, and social factors can delay recognition of psychosis presenting with predominant somatic symptoms. Early identification and intervention require integrated, longitudinal care addressing all biopsychosocial dimensions to ensure timely diagnosis and reduce morbidity. Learning points •Biological, psychological and social barriers can interact to delay recognition and treatment of psychosis. •Predominant somatic symptoms may obscure psychotic disorders, complicating diagnosis in primary and secondary care settings. •Geographic isolation, limited referral systems and financial constraints can prolong untreated illness and increase functional impairment. •Integrated, longitudinal care addressing biopsychosocial dimensions is essential for timely diagnosis, effective management and reduction of morbidity.