Modelos de atención a los síntomas somáticos sin causa orgánica: de los trastornos fisiopatológicos al malestar de las mujeres

Abstract

Somatic symptoms of no identifiable organic cause remain medically unexplained and have been delved into to only a limited degree from a biologicist conception of health. Different critical theories study contextual, gender-related and subjective factors for Somatic Symptoms of No Identifiable Organic Cause and their care models. This study has been aimed at reviewing published Spanish studies (1995-2002) exploring explanatory SSNIOC's by relating them to the underlying health theories. A search was run in Medline, Sociologycal Abstracts, Psycinfo, Doyma, Google and Scirus, using the key words: Gender and health, Primary care, Somatic complaints and women or gender, Fibromialgy, Chronic fatigue, Functional syndromes, Feminist studies and primary care, malaise women, a total of 31 articles having been selected and classified by health theories: biomedical, psychosocial, socialist, biopsychosocial, ecosocial, psychoanalytical and feminist.. Explanatory/care models were then identified by theory-related blocks, according to: terms use for SNIOC's; related/causal factors, care models, physician-patient relationship factors. Within the biomedical framework, physiopathological, directive care explanations were found focusing on the medical viewpoint, tending toward adapting the patient to his/her degree of chronicity with symptomatic and antidepressant treatments. In critical theory models: symptoms are related to the social context, subjective gender experiences, focusing on the patient viewpoint; avoiding medicalization, aimed at constructing the subjective significance of the symptoms, on empowering the woman and on her taking responsibility for herself. It is advisable to recognize the existence of theories alternative to biomedical theory which broaden the comprehension of SSNIOC's, by including contextual, gender-related subjective factors related to the wellness-illness process which give rise to care models of greater integral care potential.

Problems and solutions for patients with fibromyalgia: Building new helping relationships

“…Our study followed a similar approach to others which have demonstrated that a change in the focus of activities and beliefs about the disease could reduce symptoms and improve pain tolerance and functional status (Friedberg, Williams, & Collinge, 2012;Thieme & Turk, 2012). According to Velasco, Ruiz, and Alvarez-Dardet (2006), patients in their sample spoke of difficulties in fulfilling the traditional female gender role.…”

The social construction of fibromyalgia as a health problem from the perspective of policies, professionals, and patients

“…The same thing applies to other pathologies affecting women such as endometriosis or those that are largely diagnosed, as in anxiety and depression, which have been assigned to women in a historical sense due to a supposed greater mental frailty and vulnerability as far as the female gender is concerned (30–33). The classification of diseases and syndromes is in accordance with biomedical paradigms based on physiopathology and an objective position (7) and, consequently, the biologistic approach is unable to provide answers when changes found in signs and symptoms are not brought about by organic causes (34). As a result, diseases such as FM remain outside the biomedical classical ‘system’, which aims to identify the organic cause of disease and treat symptoms with drugs (35).…”

Asociación entre prácticas en salud, somatización y algunos factores psicosociales en usuarios de clínicas de ASSBASALUD ESE. Manizales (Colombia), 2007

“…La depresión es un grupo heterogéneo de trastornos afectivos que se caracteriza por un estado anímico decaído, disminución del disfrute, apatía y pérdida de interés por el trabajo, sentimientos de minusvalía, insomnio, anorexia e ideación suicida 34. Entre los factores que contribuyen a su incremento según la OMS, están: la longevidad, acelerados cambios psicosociales, incremento de enfermedades crónicas, altos niveles de estrés y ansiedad, antecedentes, tanto personales como familiares, de depresión y suicidio 35 . Otros factores asociados incluyen: bajo nivel socioeconómico, tabaquismo, consumo de sustancias psicoactivas, alcoholismo y disfuncionalidad familiar 34 .…”