The Psychosomatic Patient

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Just as physical illness can produce psychological problems, so can psychological problems create physical ailments. The intimate interaction of the mind and body is clearly demonstrated in the psychosomatic disorder.

Psychosomatic patients express emotional discomfort and distress in the form of bodily symptoms. They may be totally unaware of the psychological stress in their lives or the relationship of stress to the symptoms.

There are many ways of dealing with psychosomatic patients. First, identify the disorder: Do not miss the possible diagnosis of an affective or anxiety disorder. Treatment of somatization is directed toward teaching the patient to cope with the psychological problems. Be aware that somatization operates unconsciously;the patient really is suffering. Above all, the patient should never be told that his or her problem is ''in your head.'' Anxiety, fear, and depression are the main psychological problems associated with psychosomatic illness. The list of associated common symptoms and illnesses is long and includes chest pain, headaches, peptic ulcer disease, ulcerative colitis, irritable bowel syndrome, nausea, vomiting, anorexia nervosa, urticaria, tachycardia, hypertension, asthma, migraine, muscle tension syndromes, obesity, rashes, and dizziness. Answers to an open-ended question such as ''What's been happening in your life?'' often provide insight into the problems.

Finally, the interviewer should legitimize patients' suffering by acknowledging that their suffering is real. The interviewer must help patients recognize the way in which stress can create physical suffering. Giving patients the freedom to discuss hopes and fears is often more beneficial than a written prescription for medications.

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