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Somatoform disorders involve unexplained physical symptoms that bring significant distress and functional impairment. They present one of the more common and most difficult problems in primary care. They are seldom "cured" and should be approached as a chronic disease. Recognition, a patient-centered approach, and specific treatments may help alleviate symptoms and distress. Factitious disorder and malingering, although not true somatoform disorders, are addressed separately in this chapter because of their similarity in the form of medically unexplained symptoms.

Features that characterize the spectrum of somatoform disorders include the following:

  • Physical symptoms or irrational anxiety about illness or appearance, for which biomedical findings are not consistent with a general medical condition. Somatoform disorders have specific courses, symptoms, and complaints (Table 55-1).
  • Symptoms develop with or are worsened by psychological stress, and are not intentional.
  • Extensive utilization of medical care. Paradoxically, treatment and attempts to reassure patients can be counterproductive.
  • Feelings of frustration on the part of the physician. Patients are often seen as "difficult patients."

Table 55-1. Somatoform Disorders, Factitious Disorder, and Malingering.

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