Newspaper article St Louis Post-Dispatch (MO)
Physical Complaints May Have Psychological Basis
Dear Open Mind: I have a 67-year-old mother who makes frequent visits to her doctor for one problem or another. She goes to him for any number of things including headaches, back pain, "intestinal problems" and fatigue. Her doctor has expressed frustration in not finding a medical explanation for any of the problems. I have recently been approached by a relative who told me that she thinks my mother is a hypochondriac. A friend of mine who is taking a psychology course says that these are psychosomatic disorders. Can you tell me what is going on with my mother and which diagnosis best fits her condition?
Multiple physical complaints that are not explained by physical examination or laboratory findings, especially in a person over 60, are frequently seen in depressive illness. If the symptoms have a long history and have played a prominent and stable part in the patient's life, then a Somatoform Disorder (Somatization Disorder, Pain Disorder or Hypochondriasis) is a possible diagnosis.
The patient deserves a careful evaluation of the psychological issues in her life that are sources of emotional conflict. This evaluation should include an exploration of the patient's current and past life situation, to determine if there have been changes that have contributed to an added burden of emotional conflict and stress.
Changes that frequently destabilize an individual's ability to adequately cope with life stress are losses of significant personal relationships and/or losses of functional capacity from illness and/or aging.
Careful evaluation could clarify the problems that the patient has been experiencing and lead to the initiation of a treatment plan that could be of significant benefit to the patient. The "frustration" of the patient's doctor suggests that his response to the patient's complaints has foreclosed understanding of the patient's problems. An "unfrustrated" doctor would be an open-minded and careful listener and in a position to consider the psychological aspects of the patient's distress. …