Managing somatic preoccupation.

Somatically preoccupied patients are a heterogeneous group of persons who have no genuine physical disorder but manifest psychologic conflicts in a somatic fashion; who have a notable psychologic overlay that accompanies or complicates a genuine physical disorder; or who have psychophysiologic symptoms in which psychologic factors play a major role in physiologic symptoms. In the primary care setting, somatic preoccupation is far more prevalent among patients than are the psychiatric disorders collectively referred to as somatoform disorders (e.g., somatization disorder, hypochondriasis). Diagnostic clues include normal results from physical examination and diagnostic tests, multiple unexplained symptoms, high health care utilization patterns and specific factors in the family and the social history. Treatment may include a physician behavior management strategy, antidepressants, psychiatric consultation and cognitive-behavior therapy.