Florence nightingale, sometimes known as the angel of crimea, greatly improved conditions and survival for british soldiers wounded in the crimean war. after returning home, she experienced repeated bouts of debilitating illness that may have been a chronic form of brucellosis. how does the identification of a physical cause for symptoms affect the diagnosis of somatic symptom disorder? identification of a physical cause suggests factitious disorder rather than somatic symptom disorder. identification of a physical cause for symptoms rules out somatic symptom disorder. if the individual doesn't know the cause, the diagnosis of somatic symptom disorder is unaffected. the important issue is how distress affects the impairment, not the identification of a physical cause.