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The Management of Chronic Somatisation

Published online by Cambridge University Press:  02 January 2018

Christopher Bass  and
Sidney Benjamin
Christopher Bass*
Affiliation:
Department of Psychological Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU
Sidney Benjamin
Affiliation:
University of Manchester and Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
*
∗Correspondence
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Abstract

‘Somatisation’ is a process in which there is inappropriate focus on physical symptoms and psychosocial problems are denied. In some patients this process becomes chronic (in excess of six months). Special skills and strategies are required by non-psychiatrists to manage these patients, for whom the acceptance of psychiatric treatment should be facilitated. When taking the history, doctors should be aware of psychosocial cues; thereafter they should be consistent and unambiguous in their management. An agenda should be set early on, with limits on investigations. Failure to manage this group of patients is costly, and further intervention studies are required not only to reduce health service and other costs, but also to relieve the nonmonetary burden of physical and psychosocial disability on patients and their relatives.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 162 , Issue 4 , April 1993 , pp. 472 - 480
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III-R). Washington, DC: APA.Google Scholar
Barsky, A. J. & Klerman, G. L. (1983) Overview: hypochondriasis, bodily complaints, and somatic styles. American Journal of Psychiatry, 140, 273–283.Google Scholar
Bass, C. (1990) Somatization: Physical Symptoms and Psychological Illness. Oxford: Blackwell.Google Scholar
Bass, C. & Murphy, M. (1990) The chronic somatizer and the Government White Paper. Journal of the Royal Society of Medicine, 83, 203–205.CrossRefGoogle ScholarPubMed
Bass, C. & Murphy, M. (1991) Somatization disorder in a British teaching hospital. British Journal of Clinical Practice, 45, 237–244.Google Scholar
Bass, C. & Potts, S. (1993) The somatoform disorders. In Recent Advances in Clinical Psychiatry, Vol. 8 (ed. K. Granville Grossman). London: Churchill Livingstone.Google Scholar
Benjamin, S., Barnes, D., Berger, S., et al (1988) The relationship of chronic pain, mental illness and organic disorders. Pain, 32, 185–195.Google Scholar
Benjamin, S., Mawer, J. & Lennon, S. (1992) The knowledge and beliefs of family care givers about chronic pain patients. Journal of Psychosomatic Research, 36, 211–217.Google Scholar
Benjamin, S. & Bridges, K. (1993) The need for specialised services for chronic somatizers. In Liaison Psychiatry: Defining Needs and Planning Services (eds Benjamin, S., House, A. & Jenkins, P.). London: Gaskell (in press).Google Scholar
Bhatt, A., Tomenson, B. & Benjamin, S. (1989) Transcultural patterns of somatization in primary care: a preliminary report. Journal of Psychosomatic Research, 33, 671–680.CrossRefGoogle ScholarPubMed
Bridges, K. & Goldberg, D. P. (1985) Somatic presentation of DSM–III psychiatric disorders in primary care. Journal of Psychosomatic Research, 29, 563–569.CrossRefGoogle ScholarPubMed
Bridges, K. & Goldberg, D. P., Evans, G. B., et al (1991) Determinants of somatization in primary care. Psychological Medicine, 21, 473–483.CrossRefGoogle ScholarPubMed
Butler, S., Chalder, T., Ron, M., et al (1991) Cognitive behavioural therapy in the chronic fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 54, 153–158.Google Scholar
Craig, T. K. J. & Boardman, A. P. (1990) Somatization in primary care settings. In Somatization: Physical Symptoms and Psychological Illness (ed. C. Bass). Oxford: Blackwell.Google Scholar
Creed, F. H. (1992) The future of liaison psychiatry in the UK. International Review of Psychiatry, 4, 99–107.CrossRefGoogle Scholar
Creed, F. H., Mayou, R. & Hopkins, A. (eds) (1992) Medical Symptoms not Explained by Organic Disease. London: Royal Colleges of Psychiatrists and Physicians.Google Scholar
De Leon, J., Saitz–Ruiz, J., Chinchilla, A., et al (1987) Why do some psychiatric patients somatize? Acta Psychiatrica Scandinavica, 76, 203–209.Google Scholar
Deyo, R. A., Bass, J. E., Walsh, N. E., et al (1988) Prognostic variability among chronic pain patients: implications for study design, interpretation, and reporting. Archives of Physical Medicine and Rehabilitation, 69, 174–178.Google Scholar
Feinmann, C. (1985)Pain relief by antidepressants: possible modes of action. Pain, 23, 1–8.Google Scholar
Feinmann, C., Harris, M. & Cawley, R. (1984) Psychogenic facial pain: presentation and treatment. British Medical Journal, 288, 436–438.Google Scholar
Feinstein, A. R., Josephy, B. R. & Wells, C. K. (1986) Scientific and clinical problems in indexes of functional disability. Annals of Internal Medicine, 105, 413–420.CrossRefGoogle ScholarPubMed
Ford, C. V. (1983) The Somatizing Disorders. New York: Elsevier.Google Scholar
Fordyce, W. E. (1976) Behavioral Methods for Chronic Pain and Illness. St Louis: Mosby.Google Scholar
Gask, L., Goldberg, D., Porter, R., et al (1989) The treatment of somatisation: evaluation of a teaching package with general practice trainees. Journal of Psychosomatic Research, 33, 697–703.Google Scholar
Gater, R. & Goldberg, D. (1991) Pathways to psychiatric care in south Manchester. British Journal of Psychiatry, 159, 90–96.CrossRefGoogle ScholarPubMed
Goldberg, D., Gask, L. & O'Dowd, T. (1989) The treatment of somatization: teaching techniques of reattribution. Journal of Psychosomatic Research, 33, 689–695.Google Scholar
Guthrie, E. (1991) Brief psychotherapy with patients with refractory irritable bowel syndrome. British Journal of Psychotherapy, 8, 175–188.Google Scholar
Guthrie, E., Creed, F., Dawson, D., et al (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100, 450–457.CrossRefGoogle ScholarPubMed
Harkapaa, K., Jarvikoski, A., Mellin, G., et al (1991) Health locus of control beliefs and psychological distress as predictors for treatment outcome in low back pain patients: results of a 3 month follow–up of a controlled intervention study. Pain, 46, 35–41.Google Scholar
Katon, W., Ries, R. K. & Kleinman, A. (1984) The prevalence of somatization in primary care. Comprehensive Psychiatry, 25, 208–215.Google Scholar
Katon, W., von Korff, M., Lin, E., et al (1990) Distressed high utilisers of medical care. DSM–III-R diagnoses and treatment needs. General Hospital Psychiatry, 12, 355–362.Google Scholar
Kellner, R. (1991) Psychosomatic Syndromes and Somatic Symptoms. Washington, DC: American Psychiatric Press.Google Scholar
Kellner, R., Abbott, P., Winslow, W. W., et al (1987) Fears, beliefs and attitudes in DSM–III hypochondriasis. Journal of Nervous and Mental Diseases, 175, 20–24.CrossRefGoogle ScholarPubMed
Kirmayer, L. J. & Robbins, J. M. (1991) Current Concepts of Somatization: Research and Clinical Perspectives. Washington, DC: American Psychiatric Press.Google Scholar
Kleinman, A. & Kleinman, J. (1985) Somatization: the interconnections in Chinese society among culture, depressive experiences and the meaning of pain. In Culture and Depression (eds Kleinman, A. & Good, B.). Berkeley: University of California Press.Google Scholar
Lipowski, Z. J. (1987) Somatization: medicine's unsolved problem. Psychosomatics, 28, 294–297.CrossRefGoogle ScholarPubMed
Martin, R. L., Roberts, W. V., Clayton, P. J., et al (1977) Psychiatric illness and non–cancer hysterectomy. Diseases of The Nervous System, 38, 974–980.Google Scholar
Mendelsohn, G. (1991) Psychological and social factors predicting responses to pain treatment. In Proceedings of the 6th World Congress on Pain (eds Bond, M. R., Charlton, J. E. & Woolf, C. J.), pp. 193–206. Amsterdam: Elsevier Science.Google Scholar
Noyes, R., Reich, J., Clancey, J., et al (1986) Reduction in hypochondriasis in the treatment of panic disorder. British Journal of Psychiatry, 149, 631–635.CrossRefGoogle ScholarPubMed
Philips, H. C. (1987) The effects of behavioural treatment on chronic pain. Behaviour Research and Therapy, 25, 365–377.CrossRefGoogle ScholarPubMed
Pilowsky, I. (1978) A general classification of abnormal illness behaviours. British Journal of Medical Psychology, 51, 131–137.CrossRefGoogle ScholarPubMed
Pilowsky, I., Spence, P., Cobb, J., et al (1984) The Illness Behaviour Questionnaire as an aid to clinical assessment. General Hospital Psychiatry, 6, 89–93.Google Scholar
Pilowsky, I., & Barrow, C. G. (1990) A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic, intractable, “psychogenic” pain. Pain, 40, 3–19.Google Scholar
Sharpe, M. & Bass, C. (1992) Pathophysiological mechanisms in somatization. International Review of Psychiatry, 4, 81–97.Google Scholar
Sharpe, M., Peveler, R. & Mayou, R. (1992) The psychological treatment of patients with functional somatic symptoms: a practical guide. Journal of Psychosomatic Research, 36, 515–529.Google Scholar
Shaw, J. & Creed, F. (1991) The cost of somatization. Journal of Psychosomatic Research, 35, 307–312.Google Scholar
Smith, G. R. (1991) Somatization Disorder in the Medical Setting. Washington, DC: American Psychiatric Press.Google Scholar
Smith, G. R., Monson, R. A. & Ray, D. C. (1986) Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilisation. Archives of Internal Medicine, 146, 69–72.Google Scholar
Stern, J., Murphy, M. & Bass, C. (1993) Attitudes of British psychiatrists to the diagnosis of somatisation disorder. A questionnaire survey. British Journal of Psychiatry, (in press).Google Scholar
Turner, J. A. (1991) Coping and chronic pain. In Proceedings of the 6th World Congress of Pain (eds Bond, M. R., Charlton, J. E. & Woolf, C. J.), pp. 219–227. Amsterdam: Elsevier.Google Scholar
Turner, J. A. & Clancy, S. (1986) Strategies for coping with chronic low back pain: relationship to pain and disability. Pain, 24, 355–364.CrossRefGoogle ScholarPubMed
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