May be successful in young patients with no underlying medical or psychiatric illnesses with clear psycho-social stress
Unlikely to be successful in patients with chronic<unk> ation
Perceived as denial of sick role
Desire for acknowledgment and recognition → disappointment when no pathology discovered
Resistance to recovery because "specter of cure" threatens sick role
Development of new side effects, allergic reactions, and<unk> s
Perceived as denial of sick role
Desire for acknowledgment and recognition → disappointment when no pathology discovered
Resistance to recovery because "specter of cure" threatens sick role
Development of new side effects, allergic reactions, and<unk> s
Development of new side effects, allergic reactions, and<unk> s
Listen and attempt to understand patient's experience
Explain that patient's illness causes many<unk> s but does not lead to medical deterioration
Offer only guarded projections about patient's condition → safeguards sick role → may limit illness behavior
Clarify precise meaning of terms to avoid misinterpretation<unk>  responses and descriptions may be better accepted than purely psychiatric diagnoses
Hyperventilation, tension headache, muscle tension, muscle strain, muscle spasm, and stress
Communicating diagnostic uncertainty may be helpful
"atypical pain", "multiple complaints following injury"
Hyperventilation, tension headache, muscle tension, muscle strain, muscle spasm, and stress
"atypical pain", "multiple complaints following injury"
Patient with<unk>  have a high affinity for medications and are reluctant to discontinue drugs, regardless of benefit
Prioritize lifestyle modification
Benign remedies may be helpful — lotions, supplements, elastic bandages, and heating pads
Avoid drugs that cannot be safely continued indefinitely
Avoid drugs that produce abstinence syndromes or dependence
Avoid pain medications; if necessary, prescribe to be take on schedule, not "as needed"
Antidepressants may be beneficial, including tricyclics
Prioritize lifestyle modification
Benign remedies may be helpful — lotions, supplements, elastic bandages, and heating pads
Patients resist psychiatric evaluation — threatens sick role
Patients fear abandonment → reassure primary physician will continue caring for them
Patients may accept treatment as "stress management" or "education" that targets physical<unk> s and<unk>  distress.
Focus on understanding patient's subjective experience
Avoid telling patient nothing is wrong or<unk> s require no treatment
Avoid counter-transference when no physiologic explanation can be found
Attempt to retain compassion
Don't label as "difficult patient"
Avoid telling patient nothing is wrong or<unk> s require no treatment
Attempt to retain compassion
Don't label as "difficult patient"
Patients lack insight.  Do not attempt insight-oriented psychotherapy.
Do not promise or attempt cure — threatens sick role
Patient may escalate illness behaviors — new side effects, allergic reactions, and<unk> s
Reassure that patient will "probably always be ill" and should "learn to live with some pain"
Avoid unnecessary tests and procedures — may encourage<unk> ation
Focus on modification of illness behavior and improved functional status
Decreased frequency and urgency of medical use
Avoidance of expensive and hazardous procedures
Improved work or school performance
More social activities
Better personal relationships
Patient may escalate illness behaviors — new side effects, allergic reactions, and<unk> s
Reassure that patient will "probably always be ill" and should "learn to live with some pain"
Decreased frequency and urgency of medical use
Avoidance of expensive and hazardous procedures
Improved work or school performance
More social activities
Better personal relationships
Somatic symptom disorder
Medical conditions
Illness anxiety disorder
Irritable bowel syndrome
Factitious disorder
Fibromyalgia
Personality disorders
Endocrine disorders