Psychological medicine

Somatoform Disorders

  • Presence of physical symptoms that suggest a general medical condition but aren‟t explained by that condition, by substances or medications, or by another mental disorder (eg Panic Disorder)
  • Must cause significant distress or impairment in social or occupational functioning 
  • Difficult to manage: need to check for physical conditions ® constant testing ® reinforces worry. If find something on tests this validates and reinforces the worry 
  • Processes contributing to symptoms and motivation for symptom production is unconscious. They don’t know it’s not real.
  • Cultural, stress, developmental and self-esteem factors may contribute

Somatization

  • Somatic symptoms with no cause found (+/- anxiety/depression)
  • Aim of treatment is to reattribute the symptoms to relate them to psychological problems
  • Approach to managing in a non-specialise practice setting:
    • Feeling understood:
      • Take full history, including pain during a typical day
      • Watch for emotional clues or links with stressors: “what are you thinking about when it hurts”
      • Ask about social/family factors
      • Explore health beliefs: “What do you think is wrong”
      • Focused exam
    • Change the agenda:
      • Feedback results
      • Acknowledge reality of pain 
      • Reframe complaints: set them in the context of life events. “I‟m struck by the fact that these pains started shortly after … and that you‟ve been crying a lot… Do you think there might be a connection” 
    • Making the link:
      • Make the link to life events clearer to the patient
      • Use negotiating style: “Do you think that‟s possible… perhaps…” 
      • Projection: “Has anyone else suffered from symptoms like these… Did your mother get headaches – what caused those”? May be easier to see the connection in others