Quill T E
JAMA. 1985 Dec 6;254(21):3075-9. doi: 10.1001/jama.254.21.3075.
Patients with somatization disorders are frequently unrecognized and misdiagnosed. The diagnosis depends on recognizing a long-standing pattern of seeking medical intervention for vague, multisystemic symptoms, often without clear physical cause. These patients use symptoms as a way to communicate, express emotion, and be taken care of. Instead of recognizing the disorder and exploring psychosocial contributors to illness, nonpsychiatric physicians tend to repeatedly pursue organic possibilities through multiple tests, procedures, medications, and operations. In patients with somatization disorders, the dollar costs of this strategy are only exceeded by its potential for iatrogenic harm. More productive treatment strategies are presented, emphasizing the need for a long-term relationship with a primary care provider who will treat the patient and his symptoms seriously and respectfully but who is not compelled to invasively evaluate all symptoms.
躯体化障碍患者常常未被识别和误诊。诊断依赖于识别出一种长期存在的模式，即患者因模糊的多系统症状寻求医疗干预，而这些症状往往没有明确的身体原因。这些患者将症状作为一种沟通、表达情感和获得照顾的方式。非精神科医生往往不认识这种障碍，也不探究疾病的社会心理因素，而是倾向于通过多次检查、程序、药物和手术反复寻求器质性病因。对于躯体化障碍患者，这种策略的金钱成本仅次于其造成医源性伤害的可能性。文中还介绍了更有效的治疗策略，强调需要与初级保健提供者建立长期关系，该提供者要认真且尊重地对待患者及其症状，但不必对所有症状进行侵入性评估。
