SOMATIC PRESENTATION OF PSYCHIATRIC MORBIDITY IN GENERAL-PRACTICE

Background. Twenty per cent of new illnesses in general practice, and 3% of consecutive attenders, are incident cases of 'pure' somatization . Aim. This study set out to estimate the prevalence of consultations by patients with psychiatric morbidity who present only somatic sympto ms (somatic presentation), and to compare this with the likely prevale nce of pure somatization. Method. A cross-sectional survey of consecut ive general practice attenders was carried out. Psychiatric morbidity was measured using the general health questionnaire. Pure somatization was defined as medical consultation for somatic symptoms that were ju dged by a psychiatrist during an interview to be aetiologically attrib utable to an underlying psychiatric disorder but which were not recogn ized as such by the patient. Results. Of attenders 25% were identified as somatic presenters. Of the somatic presenters interviewed one in s ix were estimated to be pure somatizers, which would extrapolate to 4% of attenders. Though all somatic presenters were probable cases of ps ychiatric disorder, subjects in this group had lower scores on the gen eral health questionnaire than those who presented with psychological symptoms. General practitioner recognition of psychiatric morbidity wa s significantly lower among somatic presenters than for other subjects with psychiatric morbidity. Conclusion. General practitioner recognit ion of psychiatric morbidity could be improved for all types of somati c presentation, regardless of the aetiology of patients' somatic sympt oms. There is a danger that concentrating attention on pure somatizati on may mean that psychiatric morbidity in the more common undifferenti ated form of somatic presentation will be overlooked.