A patient with an underlying mood disturbance presents primarily with physical complaints. Before revealing the answer, decide what distinguishes somatisation from denial.

Ask whether the person is genuinely experiencing and presenting their distress through bodily symptoms, or actively refusing to acknowledge the distress or situation itself. Somatisation differs from denial in that the person is not refusing to acknowledge distress, but rather is genuinely experiencing and presenting it primarily through the body — depressive features become apparent only with specific, direct enquiry into mood, sleep, interest, and related areas, not because the patient is resisting acknowledging them. Denial, by contrast, is a refusal or apparent inability to acknowledge the emotional significance, or sometimes even the basic facts, of a distressing situation, involving an active pushing-away of acknowledgement. Whether distress is being genuinely channelled through physical symptoms, or actively refused acknowledgement altogether, is the key distinguishing feature.