Managing somatic preoccupation

Somatically preoccupied patients are a heterogeneous group of persons who h ave no genuine physical disorder but manifest psychologic conflicts in a so matic fashion; who have a notable psychologic overlay that accompanies or c omplicates a genuine physical disorder; or who have psychophysiologic sympt oms in which psychologic factors play a major role in physiologic symptoms. In the primary care setting, somatic preoccupation is far more prevalent a mong patients than are the psychiatric disorders collectively referred to a s somatoform disorders (e.g., somatization disorder, hypochondriasis). Diag nostic clues include normal results from physical examination and diagnosti c tests, multiple unexplained symptoms, high health care utilization patter ns and specific factors in the family and the social history. Treatment may include a physician behavior management strategy, antidepressants, psychia tric consultation and cognitive-behavior therapy.