Splintered Reflections: Images of the Body in Trauma

By Jean Goodwin; Reina Attias | Go to book overview

CHAPTER 3
Assessment and Management
of Somatoform Symptoms
in Traumatized Patients
Conceptual Overview
and Pragmatic Guide

Richard J. Loewenstein
and Jean Goodwin

The association between traumatic life events and somatoform symptoms has been described repeatedly in the medical literature for over 150 years ( Loewenstein 1990). Despite this historical finding and more sophisticated modern studies that support it, physicians and psychiatrists remain relatively unaware of the phenomenon. This professional blind spot has costs not only to the individual patients who receive inadequate assessment and treatment, but to society as a whole. It is well known that inappropriate medical interventions for somatoform symptoms lead to substantial unnecessary expenditure of health-care dollars ( Cummings 1992; Smith, Monson and Ray 1986). There is a similar cost to society due to the medical sequelae of childhood maltreatment, a finding that is just beginning to be appreciated ( Felitti et al. 1998).

The potential scope of these interrelated problems is considerable. Surveys report that during any week, 60 to 80 percent of the general population will suffer a somatic symptom ( Cassem 1987; Kellner 1985). Other data show

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