Summary

In summary, the following points should be noted:

1. Somatoform illness is one of the most common forms of psychiatric disorder encountered within the health care system and is associated with high levels of resource utilization.

2. Almost every symptom of organic illness has an ''unexplained'' (i.e., somatoform or conversion) counterpart.

3. In some cases, unexplained medical symptoms have positive features (e.g., internal inconsistency) that are indicative of a somatoform diagnosis; however, other somatoform symptoms closely resemble the symptoms of organic disease.

4. Comorbid psychopathology, particularly depression, anxiety, and personality disorders, is extremely common in patients with unexplained medical symptoms; comorbid organic pathology is also common in these patients.

5. The diagnosis of somatoform illness involves careful history taking, the exclusion of physical illness through appropriate investigation, and the assessment of psychiatric morbidity.

6. Management of somatoform illness involves containing the patient's symptoms and distress, limiting their access to investigations and hospitalizations, and preventing iatrogenic damage; careful consideration must be given to whether a formal diagnosis of somatoform illness should be used and, if so, how such a diagnosis should be presented.

7. A typical therapeutic approach involves the use of reassurance, symptomatic treatments and, where necessary, psychological intervention; the prognosis of somatoform illness is quite good, with acute symptoms being more responsive to treatment than chronic symptoms.

8. Current theorizing concerning unexplained medical symptoms is dominated by the concepts of dissociation, conversion, and somatization. Although there is limited evidence in support of these concepts, they fail to provide a complete account of the psychopatho-logical mechanisms underlying these conditions.

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