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Re: somatoform disorder(s) » fires

Posted by Larry Hoover on July 23, 2004, at 8:22:41

In reply to one small step for me, posted by fires on July 16, 2004, at 10:49:17

> I complained too much about my physical symptoms, apparently. Anyway, my Pdoc ignored the following FACTS: 1) Too much Effexor was responsible for some of the symptoms (they went away when my dose was lowered) 2) I had OBJECTIVE data (x-rays, biopsy, cardiac event recorder data, BP and Pulse data) to support nearly all of my physical complaints.

First off, I can be certain that the doctor did not ignore the factual medical evidence. In somatoform disorders, the symptoms are real. The suffering is real. There may also be concurrent medical disease. The one type of diagnosis does not exclude the other.

What sets somatoform apart (there are a number of different sub-types, but you don't further specify) is that following a series of diagnostic tests and assessments, no underlying disease state can be found.

> I'd urge everyone who reads this to never accept a DX of Somataform Disorder because it can not be proven with OBJECTIVE tests. It is a SUBJECTIVE disorder.

It is a syndrome which is defined by the failure to diagnose other disorders first (a process called the differential diagnosis). It's what's left, when you checked everything else. The objective tests failed. You're right that it isn't proven with objective tests. It's reluctantly assessed because of objective tests, though. Chronic fatigue syndrome is another example of diagnosis by exclusion. Personality disorders, too.

> The recommended treatment is still largely psychobabble. (Which is why I posted this here).

The recommended treatment is still *medical*. It is supportive symptomatic treatment, with reassurance (based on negative objective test results) that there isn't any evidence of a serious disease. From the Merck Manual: "Usually, the best treatment is a calm, firm, supportive relationship with a physician who offers symptomatic relief and protects the patient from unnecessary diagnostic or therapeutic procedures."

 

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poster:Larry Hoover thread:366835
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