Hypochondriasis and somatization disorder: New perspectives

Abstract

The blurred boundaries between illnesses presenting with somatic symptoms confronts both psychiatrists and primary care physicians with one of the most challenging issues in patient care. On a typical day in a general physician’s office, perhaps 50 % or more of the patients with physical complaints will have no definitive explanation for their ailment (Simon et al. 1996; Kroenke and Mangelsdorff 1989; Kroenke 2003; Baumeister and Harter 2007; Smith and Dwamena 2007). The patients present with distress from fatigue, chest pain, cough, back pain, shortness of breath, and a host of other painful or worrisome bodily concerns. For most, the physician’s expression of interest, taking a thorough history, doing a physical examination, and offering reassurance, a modest intervention, or a pharmacologic prescription suffices to assuage the patient’s pain, anxiety, and physical distress. But for some, these simple measures fall short of their expected result, marking the beginning of what may become a chronic search for relief, including frequent anxiety-filled visits to more than one physician, and in extreme cases even multiple hospitalizations and possibly surgery.