A 41 -year-old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has lack of interest in work and doesn’t like to meet friends and relatives. She denies feelings of sadness. Her most likely diagnosis is

**Core Concept**
The patient's presentation of aches and pains, generalized weakness, sleep disturbances, loss of appetite, and social withdrawal suggests a diagnosis of a chronic and debilitating condition that affects multiple aspects of her life, including physical and mental health.

**Why the Correct Answer is Right**
The patient's symptoms, particularly the lack of interest in work and social activities despite denying feelings of sadness, are characteristic of Depressive Disorder, specifically Persistent Depressive Disorder (PDD). This condition is characterized by a pervasive and persistent low mood, anhedonia (loss of interest in activities), and social withdrawal, lasting for at least two years. The patient's somatic complaints, such as aches and pains, are common in PDD and can be a manifestation of the underlying depression.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because the patient denies feelings of sadness, which is a key symptom of Major Depressive Disorder (MDD).

**Option B:** This option is incorrect because the patient's symptoms, such as lack of interest in work and social activities, do not meet the criteria for Adjustment Disorder, which typically involves a more transient response to a specific stressor.

**Option C:** This option is incorrect because the patient's symptoms, such as sleep disturbances and loss of appetite, do not meet the criteria for Hypersomnia or Hypersomnolence Disorder, which involve excessive sleepiness or sleepiness, respectively.

**Clinical Pearl / High-Yield Fact**
It's essential to note that patients with Depressive Disorder can present with somatic complaints, such as aches and pains, which can mask the underlying depression. Clinicians should be aware of this phenomenon and investigate for underlying mood disorders in patients presenting with unexplained somatic symptoms.

**Correct Answer:** D.

✓ Correct Answer: B. Major depression