Approach to the Somatizing Patient

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Voluntary Psychogenic Symptoms or Syndromes

Factitious, with physical symptoms (e.g. Munchausen's syndrome)
Malingering, with physical symptoms

Table I provides a differential diagnosis for the patient presenting with somatic symptoms. This section will provide a brief approach to the somatizing patient while the next chapter (DFH-PSY-4) focuses on somatoform disorder, especially conversion, hypochondrium and pain.

It must be remembered that there are pitfalls associated with both over diagnosis and under diagnosis of somatization. Over diagnosis results in failure to identify and treat other illness increasing morbidity and mortality. Under diagnosis results in expensive diagnostic tests, unnecessary cost and an iatrogenic reinforcement of the patient's belief that an undetected underlying physical illness remains.

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