Abstract
Physical complaints, as tickets of admission to see physicians, are the verbal media by which doctor and patient exchange information. The diagnostic process for such complaints should allow a mutual understanding of the classification and cause of the problem that led the individual to seek medical evaluation [1]. When appropriate physical examination and laboratory data reveal no organic pathology to account for etiology or intensity of the complaint, the phenomenon is called somatization [2].* Although somatization is a process found in many illnesses, the DSM-III-R has operationally delineated, in the section “Somatoform Disorders,” the psychiatric disorders in which somatization is the predominant feature [3, 4]. Although the prevalence of somatization disorders varies widely, Kellner suggests that anywhere from 10% to 30% percent of patients in outpatient specialty clinics suffer from a variety of somatization difficulties [5], The clinical management of such disorders is difficult and continues to vex physicians of all specialties as well as the patients who suffer from such problems [6]. Engel has urged physicians to incorporate a biopsychosocial model that would include psychological issues as well as social phenomena in addition to biologic data to understand the problems with which patients present [7]. Slavney and McHugh [8, 9] have extended such an approach by demonstrating that psychiatry must be viewed from multiple perspectives, each of which has its own specific logic and internal grammar. From a developmental and life history perspective, psychological phenomena differ from the biologic model. These different perspectives do not allow fluid transition between each view. Nevertheless, the clinician must understand the inherent strengths and weaknesses in each perspective and utilize them concurrently to best assess and manage the complex clinical problems that are routinely encountered. Incorporation of these perspectives offers the consultation psychiatrist a systematic approach to understand patients who present with the somatization disorders found in consultation psychiatry.