Somatization and illness behaviour in a neurology ward

Differential Diagnosis of Hypochondriacal Fears and Beliefs

“…Such criticism, however, often only pro vides an indirect measure of its clinical im portance, since it dismisses widely replicated findings obtained with the Illness Behavior Questionnaire [7] and does not offer viable alternatives to describing forms of abnormal illness behavior and somatization commonly encountered in medical wards [20][21][22]. Within the illness affirming forms of abnor mal illness behavior, there seems to be room for a better specification of the subheading hypochondriasis.…”

“…Yet, what is the clinical value of such differentia tions? It has been emphasized that current psy chiatric classification systems, such as the DSM-III-R [3], have limited value in medi cal populations characterized by functional somatic complaints and abnormal illness be havior [20][21][22], We applied a clinical differ entiation of hypochondriacal fears and be liefs based on the IAS, yet obtained through interview, to patients suffering from cardiac neurosis (neurocirculatory asthenia). Table 1 displays the differences between a DSM-III-R classification and our expanded clinical analysis in 7 of 54 patients described in a preliminary report [23], Only for 2 patients was there concordance of the two methods.…”

The Concept of Psychosomatic Disorder

“…Certainly the last decade has witnessed a renaissance in psychiatric diagnosis, and this progress has been most impressive in the field of affective disorders. A substantial improvement in their definition and assessment has resulted in a potentially higher likelihood of their detec tion in medical practice, even though the skills of physicians as to this aspect are still poor [7], If we consider any functional disor der, whether gastrointestinal [8], neurologic [9], or cardiologic [10]. we may find that in many cases the label somatization is simply part of the clinical manifestations of an affec tive disorder, such as a major depressed epi sode in irritable bowel syndrome [8] or panic disorder with agoraphobia in cardiac neurosis [10].…”

Sick-Role Susceptibility

“…Put simply, illness behavior in this study was a disgruntled patient whom the physician was unable to diagnose. Such a conclusion is not confined to primary care since similar find ings of inexplicable amounts of suffering have been noted on a neurology ward [ 12].…”