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A MODEL FOR LOOKING AT PATIENTS WHO SOMATISE

 (See Tim Usherwood Chapter 9 Understanding the consultation; evidence theory and practice  OUP 1999) 

Blacker (1991) has suggested a useful classification grouping somatising patients into three categories: 

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disguisers 

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 deniers 

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don’t knows

 Disguisers recognise that they have a psychological complaint but present to the doctor with a physical complaint as a ticket of admission. 

Deniers tend to resist exploration of psychological issues and often develop chronic somatic illnesses. 

Don’t knows are aware of emotional or psychological issues, but present with physical symptoms because they are worried they reflect physical disease. 

Goldberg (1989) has suggested a  useful approach to patients who somatise. 

·     Making the patient feel understood

(discover the illness framework)

·     Changing  or broadening  the agenda

(offering to take the patient’s physical symptoms seriously and at the same time introducing the possibility that there may be an emotional cause)

·     Making the link

(giving an explanation of the symptoms which the patient can understand)

 The above approach will not usually be helpful in dealing with “deniers” who need empathy and full attention given to the possible physical reasons for their symptoms. Usually a long period of building up the relationship with the patient will be necessary, with regular appointments.

 

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