Psychogenic Disorders: A Pragmatic Approach for Formulation and Treatment

ABSTRACT

Four perspectives can provide a comprehensive yet flexible approach to the evaluation of a patient in distress with a psychogenic disorder. Each individual patient will have a different combination of the four perspectives that formulate the patient's problems. The perspectives identify the patient with a psychogenic disorder as a patient who is a composite of personal vulnerabilities and strengths but afflicted with diseases, struggling through life events, and motivated to behave for various reasons. Each individual perspective has its own logical process for evaluation and subsequently directed treatment. Although the perspectives are complementary, they each remain distinct and essential to the formulation of a patient's disability. This comprehensive and integrated formulation of a patient supports an approach to complex psychogenic cases that defy a simple list of diagnoses and nonspecific treatments. The patient does not have to fit into one theoretical approach to receive an available treatment. The treatments prescribed are now designed from the individual formulation and relevant perspectives.

KEYWORDS

Psychogenic - disease - behavior - meaning - personality traits - treatment

REFERENCES

• 1 Meimark G, Caroff S N, Stinnett J L. Medically unexplained physical symptoms.  Psychiatr Ann. 2005;  35 298-305
• 2 Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis.  J Neurol Neurosurg Psychiatry. 2005;  76(suppl 1) i2-i12
• 3 Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis.  J Psychosom Res. 2004;  56 391-408
• 4 Barsky A J. A comprehensive approach to the chronically somatizing patient.  J Psychosom Res. 1998;  45 301-306
• 5 Kirmayer L J, Groleau D, Looper K J, Dao M D. Explaining medically unexplained symptoms.  Can J Psychiatry. 2004;  49 663-672
• 6 McHugh P R, Slavney P R. Perspectives of Psychiatry. 2nd ed. Baltimore; The Johns Hopkins University Press 1998
• 7 Slavney P R. Perspectives on “Hysteria”. Baltimore; The Johns Hopkins University Press 1990
• 8 McHugh P R, Slavney P R. Methods of reasoning in psychopathology: conflict and resolution.  Compr Psychiatry. 1982;  23 197-215
• 9 Clark M R, Cox T S. Refractory chronic pain.  Psychiatr Clin North Am. 2002;  25 71-88
• 10 Clark M R, Swartz K L. A conceptual structure and methodology for the systematic approach to the evaluation and treatment of patients with chronic dizziness.  J Anxiety Disord. 2001;  15 95-106
• 11 Rief W, Barsky A J. Psychobiological perspectives on somatoform disorders.  Psychoneuroendocrinology. 2005;  30 996-1002
• 12 Brown R J. Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model.  Psychol Bull. 2004;  130 793-812
• 13 McHugh P R. A structure for psychiatry at the century's turn: the view from Johns Hopkins.  J R Soc Med. 1992;  85 483-487
• 14 Clark M R. Psychiatric conditions presenting as neurologic disease: conversion disorder and hysteria. In: Johnson RT, Griffin JW, McArthur JC Current Therapy in Neurological Diseases. 6th ed. St. Louis; Mosby 2002: 428-431
• 15 Ford C V. Somatization and fashionable diagnoses: illness as a way of life.  Scand J Work Environ Health. 1997;  23(suppl 3) 7-16
• 16 Reuber M, Mitchell A J, Howlett S J, Crimlisk H L, Grunewald R A. Functional symptoms in neurology: questions and answers.  J Neurol Neurosurg Psychiatry. 2005;  76 307-314
• 17 Clark M R, Treisman G J. Perspectives on pain and depression.  Adv Psychosom Med. 2004;  25 1-27
• 18 Kirmayer L J, Robbins J M. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics.  J Nerv Ment Dis. 1991;  179 647-655
• 19 Mayou R, Kirmayer L J, Simon G, Kroenke K, Sharpe M. Somatoform disorders: time for a new approach in DSM-V.  Am J Psychiatry. 2005;  162 847-855
• 20 Rief W, Nanke A. Somatoform disorders in primary care and inpatient settings.  Adv Psychosom Med. 2004;  26 144-158
• 21 Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: management.  J Neurol Neurosurg Psychiatry. 2005;  76(suppl 1) i13-i21