Physical symptoms and complaints

In somatization disorder and related disorders the patient presents with physical complaints unaccounted for by pathological findings (i.e. medically unexplained) and attributes them to physical diseases.

The typical presenting physical complaints have varied throughout history and with the sociocultural environment of the patient. Patients with somatization disorder may complain of any medically unexplained non-verifiable subjective physical symptoms and the symptoms may refer to any part or system of the body. Subjective symptoms are sensations and other complaints that cannot be verified by another individual or by general methods of examination (e.g. pains and paraesthesia). Subjective symptoms may be considered to be psychological phenomena arising from personal experiences which others cannot judge or measure, despite the fact that these symptoms could be fully explained by the presence of organic pathology. The only limitations on the types of subjective bodily symptoms presented seem to be the patient's imagination and medical knowledge. The considerable interindividual, cultural, and historical variations may be attributed to the element of 'suggestibility' in the aetiology.(11) The nature of the presenting symptoms is determined by the patient's life experience, sociocultural background, and the setting in which the patient is seen.

Patients may also present with verifiable symptoms and signs due to a physical disease or defect (e.g. haematuria, icterus, etc.) which they exaggerate and incorporate into their illness. Findings may be divided into two categories—provoked and certain. Provoked findings are symptoms (such as soreness resulting from pressure) or sensory impairment, where the patient is unaware of symptoms or signs until these are provoked during the medical examination. The second category (certain findings) includes objective symptoms that can be verified and also phenomena unnoticed by the patient, such as an abdominal tumour. Incidental inborn errors or degenerative changes, which are asymptomatic in most individuals, may tenuously be assigned clinical importance. Some patients self-inflict illness or manipulate tests; for instance, they may simulate a fever by heating the thermometer (factitious illness).(1) Furthermore, over time, the patient is likely to have undergone multiple tests, invasive procedures, operations, and medications for treatment or diagnostic purposes, and these may cause not only iatrogenic psychological problems but also organic complications.(1) Finally, the patient may have a concurrent physical disease. The presented symptoms may thus be a difficult mixture of complaints of both organic and non-organic origin.(1)

The presentation of medically unexplained symptoms is usually atypical, that is to say the symptoms lie outside what is usual in an authentic physical disease. (12) Because of their suggestibility, patients with somatization disorder may have 'learned' the typical symptom presentation from different sources. For example, a patient with atypical asthma-like attacks shared a room with a patient with genuine asthma during her third hospital stay; subsequently, her attacks took on a more 'authentic' appearance/1.)

Descriptions of symptoms are usually vague, imprecise, and inconsistent, and the patients often have difficulties in giving further details about their illness. They may also have difficulties in describing the chronology of symptoms, mixing current and past symptoms and illness episodes in a disorganized and confusing manner.

The most frequent symptoms are non-specific in character^2) and of low diagnostic value. These may include fatigue, nausea, pain, dizziness, and palpitations, all of which can be encountered in many different mental and physical disorders.

Some patients show a lack of concern about the nature and implications of their symptoms (la belle indifference) and there may be a striking discrepancy between the patient's subjective complaints and behaviour. For example, a patient may smile, walk, and move normally when reporting severe intolerable pain in muscles and joints.

The number of medically unexplained symptoms reported by the patients varies considerably from one patient to another, and over time in the same individual. The patient may complain of multiple, medically unexplained symptoms in numerous bodily systems at presentation. However, more often the complaints are concentrated on one symptom pattern at one time (e.g. a gastrointestinal disorder) and on a different symptom pattern at another (e.g. a cardiopulmonary disorder). (1) Typically, a new set of symptoms will emerge when all possible diagnoses and treatment options have been ruled out for the current complaint. Iatrogenic factors may thus contribute significantly to changes in symptom pattern.

Patients with somatizing disorder are inconsistent historians. They may supply incorrect information about previous episodes of their illness, minimizing or ignoring earlier instances of illness and exclusively focusing on the current symptom pattern. Therefore, the full clinical picture may only become evident when a full medical history has been obtained and when the patient has been followed for some time.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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