Strategic Principles for Working with Somatic Patients

Key Points

• Trying to explain somatic symptoms through a medical workup is the usual approach, although this is not always effective.

• Parallel diagnostic inquiry can help the physician maintain a therapeutic relationship with somatizing patients, even when physical explanations for symptoms cannot be found.

• Positive diagnostic features of somatization (chronicity, number of symptoms, patient defensiveness, provider suspicion, psychosocial evidence, medication history) help the clinician judge the likelihood that symptoms are somatoform.

• Emotion-focused interviewing may prove to be a useful technique for diagnosing specific subsets of somatizing behavior.

• The somatoform module of the PRIME-MD, or its self-administered counterpart, the PHQ-15, is the best diagnostic instruments for the clinician to use for formal diagnosis of somatization in primary care.

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