How Physicians View Stress Illness (2)

In the last post, a quotation from Dr Jerome Groopman highlighted two common physician errors, the first being to lump together all patients with medically unexplained symptoms and label them hypochondriacs.

Hypochondria is anxiety about having a serious illness that is not relieved by factual information to the contrary.  This condition was rare in my practice with only a handful seen in my office over 25 years.  Treating it as a form of anxiety disorder is likely the best approach.

Also relatively uncommon is another cause for unexplained illness, Somatization Disorder.  Here the patient is not particularly anxious and accepts factual information about their condition.  Symptoms in these patients often improve, only to be replaced by a new, equally unexplainable illness.  These patients respond best to regular medical follow-up visits consisting of sympathetic listening, a physical exam focused on the complaint of the moment, reassurance, a minimum of diagnostic testing and scheduling another follow-up visit at a slightly longer interval than the last visit.  Identifying and treating their psychosocial stresses is usually not helpful.

The third and by far most common cause for illness with no identifiable physical cause is Psychophysiologic Disorder or PPD, the new technical term for Stress Illness.  Symptoms usually can be linked to psychosocial stress and typically improve when the stress is identified and treated.  This is not the case for Hypochondria or Somatization Disorder.  These patients accept factual information about their condition.  Some of them suffer from an anxiety disorder but it is not focused on fear of an underlying serious illness.  They often have multiple symptoms but their illness is much more stable over time than in Somatization Disorder.

The second major error highlighted by Dr Groopman will be described in the next post.

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