Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 32F, Fatigue, Migraines, Mild Bradycardia, Mild Anemia,Hi Reddit,My girlfriend has chronic fatigue, migraines, weakness, dizziness, and occasional stomach pains which cause her to be unable to work or leave the home somewhere around 1 in 4 days. She has been to several doctors who all use a very compartmentalized approach that simply finds nothing. Getting her to go to more doctors is a challenge, partly because of the fatigue but also because it seems to go nowhere (and I can't blame her). Here's the medical history as we've found it so far:Basic InfoWhite female32 years oldBorn Russia living in United States5'2", 95 lbs.No tobacco, vape user, moderate drinkerLittle useful family historySymptomsMigraines and other headaches, 1-2x/wk, varying in response to NSAIDs and triptans (sometimes helps, sometimes doesn't)Often feels dizzy or says room goes black when she "stands up too fast"Can also black out under substantial stressCold hands/feet that she sometimes complains are numbLast year had several instances of extremely severe stomach pain, once resulting in hospitalization (has no reoccurred this year), no cause foundFatigue 3-5x/month severe enough to not leave home even without complaints of headacheDepression, PTSD-like symptoms from childhood traumaRecently measured heart rate of 57 bpm in eveningDiagnostics AttemptedHead and abdomen CT & MRI, negativeColonoscopy, Dx: gastritis, recommended treat with PPI and dietBloodwork, positive results: mild anemia (says all bloodwork since childhood was same), mild vitamin D defBloodwork, negative results: CBC and other basic hematology, thyroid issues, Lyme diseaseRx / TreatmentNexplanon implant (~2 years)J&J corona vax, 3/2020, no boost (previous infection: Delta)Bupropion + psychotherapy for depressionVitamin DIbuprofen and/or triptans for migrainesAdd'l InfoOften has trouble sleeping at night, ends up sleeping in morning until early afternoonDiet could be better (eats at random times, often not the healthiest foods)Does not exercise (dislikes running, weight lifting, outdoor activities in sun/heat)Stress seems to trigger episodes but can happen even without stress triggerAnyone have any idea what to try next for diagnostics? The reading of 57 bpm is a newer symptom and was contemporaneous with the cold/numb extremities, so perhaps some kind of cardiology workup? Having a partner that is constantly sick with no idea what's going on is stressing us and our relationship, but more importantly worries me that something significant may be being missed.. ### Response: HR of 57 is normal.I know you said doctors have used a very compartmentalised approach, but I would actually use the term thorough.Incredibly so. While I appreciate how frustrating it can be for all of these things to come back negative, it is reassuring that theres no gross medical abnormality.The tests she has had are all incredibly sensitive and have even been repeated in different modalities, so the chance something has been missed is slim to none.I strongly suspect that what youre seeing is the effects of a functional disorder. With a functional disorder, there is no physical pathology resulting in symptoms. Rather, the symptoms are a manifestation of psychological trauma and/or psychiatric issues; two things that we know your partner unfortunately has.It is important to note that these symptoms are incredible real for the individual, even in the absence of physical pathology. This is not faking in any way.Your partners history is highly typical of this: general, multi-system symptoms with normal investigations.The management of these conditions is challenging. When theres a physical pathology, we can target it. When there isnt, theres nothing physical for us to target.That leaves us with the non-physical targets, which in this case is psychology/psychiatry. The most effective treatment for functional disorders with a known mental health history is treatment of said mental health history through a combination of medical and talking therapies..