Assess for somatic symptom disorder while validating her symptom experience, screening for comorbid anxiety, depression, and trauma history that may be driving somatic amplification.

Globus sensation (the feeling of a lump in the throat) is one of the most common somatic presentations in psychiatric practice. After appropriate medical workup has been completed and is negative, the PMHNP should assess for anxiety disorders, depression, recent stressors or losses, and the patient's health-related beliefs and behaviors. Reassurance alone is typically insufficient — acknowledge the symptom is real while exploring the psychological contributors. Somatic symptom disorder requires excessive thoughts, feelings, or behaviors related to the symptom. Trauma screening is essential as adverse childhood experiences strongly predict adult somatization.

Repeat the ENT referral for a more thorough re-evaluation, as the initial laryngoscopy may have missed a structural abnormality given the persistence and daily occurrence of her symptoms.

Repeating the same workup reinforces the cycle of somatic preoccupation and medical reassurance-seeking without addressing the underlying issue. Laryngoscopy and upper GI series provide adequate evaluation.

Diagnose illness anxiety disorder based on her persistent fear of cancer despite two normal medical evaluations, as the cancer fear with negative workups meets DSM-5 criteria for this condition.

Illness anxiety disorder features minimal somatic symptoms with maximum illness preoccupation. This patient has a prominent somatic symptom (globus sensation), making somatic symptom disorder more appropriate if criteria are met. The distinction matters for treatment planning.

Start an SSRI targeting the somatic complaint and cancer-related anxiety, as prolonged untreated symptoms risk further functional decline and entrenchment of the somatic preoccupation pattern.

Starting medication without completing the psychiatric assessment and establishing a diagnosis is premature. A thorough assessment of comorbid conditions, psychosocial contributors, and the patient's beliefs about her symptoms should precede treatment decisions.