Approach to the Somatizing Patient

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Evaluation

The evaluation of a somatizing involves a thorough relevant history and physical examination. It must be remembered that somatization is commonly found in patients who have symptoms similar to those of a physical illness, for instance the patients who have idiopathic epilepsy may also have pseudoseizures (conversion seizures).

Several clues can alert the physician about the somatization disorder. In addition to a thorough and reasonable search of physical illness.

1. Use of standard questionnaires

2. Giving the patient latitude to express his/her feelings and asking specific (though subtle) questions about recent or chronic stressful situations and questions about presence of delusions, paranoia and suicidal ideation may provide valuable clues.


3. Paying attention to the manner in which the patient interacts with you is often revealing. (a) Is the patient dramatic, anxious, depressed, angry, passive, bizarre or paranoid

(b) Do attempts to reassure fall on deaf ears (c) Does the patient seem to value a relationship with you more than relief of symptoms.

4. Your own unresponse to patients

may also give a clue to the presence of somatization. Especially the chronic type found in somatization disorder and hypochondriasis.

Patients who are disliked by physicians are more likely to have organic brain disorder, somatoform disorder, personality disorders and substance abuse. A few questions that you can ask yourself may provide a clue to whether the patient has a somatoform disorder.

a) Do you dread a phone call or the next appointment of this patient ?

b) Are you angry or feeling anger in wasting your time with this patient ?

c) Does it seem that the patient is working against you?

If your answer to these questions are "Yes" you should consider that the patient may be somatizing.

Somatizing patients may have coexistent true illness.

Allow patient to express himself/herself.

Ask for stressful situations.

Examine the patients interaction with you.

Examine your response to the patient.

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