Snapshot A 20-year-old young woman presents with a long course of abdominal pain that is relieved by defecation and relaxation. She can remember this pain for her entire life, and it is currently worse during her final exams. The patient has been worked up thoroughly and has had fecal leukocytes and RBC's as well as a stool culture reveal no abnormalities. She had a colonoscopy performed 3 months ago that revealed no underlying pathology as well. She is very concerned about her abdominal pain, and on exam you see a very anxious young woman. Introduction An idiopathic functional disorder characterized by: abdominal pain irregular bowel habits Patients most often present in teens and 20s 50% of patients have comorbid psychiatric disorders Presentation Symptoms abdominal pain alternating diarrhea and constipation abdominal distention rarely awakens patients at night Physical exam usually unremarkable may have mild abdominal tenderness Evaluation Diagnosis of exclusion Treatment Psychiatric patients need assurance from their physicians Place on a high fiber, low fat diet Antidiarrheal (loperamide) medications and antispasmodics TCA's (amitriptyline) - reserved as ultimate therapy