Abnormal Illness Behavior

The same principle applies to the management of illness behavior that is not produced by major psychiatric illness. Patients who are obsessively concerned about relatively minor problems will need continued medical care and support as they are helped to become reabsorbed into their work and family lives. In the absence of true psychiatric illnesses like depression, some personality traits may place patients at high risk for somatic symptoms and the conviction of illness. Extraverted persons tend to be vulnerable to suggestion and influence, and may report frustratingly protean symptoms. Individuals with obsessive traits have great difficulty accepting reassurance once a notion has taken root, and may defend the notion with endless new observations and "what ifs." Indeed, it has been observed that patients with somatization disorder often manifest both kinds of traits—extraverted dispositions that render them vulnerable to sensation and ideas about them, and obsessive traits that make it difficult to abandon these experiences. Modest intelligence and impoverished behavioral repertoires (and even very substantial resources may be taxed by some levels of challenge) may leave some individuals with few alternatives to the sick role in coping with demands the fear they cannot meet. It is rarely helpful to try to persuade patients that their symptoms are not real. The physician must first persuade the patient that he or she fully understands that a psychological diagnosis provides no immunity to other medical conditions, and that he or she has not lost interest in the patient's health and treatment. Such patients tend to do better if they are approached from a "rehabilitation" rather than a curative perspective and supported for their courage and determination in returning to their lives despite their health concerns rather than encouraged to relinquish those concerns altogether. It is usually much more helpful to focus on overcoming barriers to that re-absorption rather than on historical problems that may appear to have caused or maintained their medical preoccupations.

In some instances, conversion symptoms and even some factitious symptoms (eg, laxative abuse) may respond rapidly when the complaints are met with studious inattention and the patient is redirected and supported in addressing the conflicts or demands underlying their appearance. Family and other intimates may be engaged in supporting "rehabilitation" without anyone being confronted with the hypothesized "psychogenic" nature of the complaints. In most cases of somatization disorder and hypochondriasis, however, where illness has become a way oflife (Ford, 1983) management becomes more a matter of long term support and "damage control" than of cure or resolution. The most effective element of treatment is the doctor-patient relationship, and it is often the doctor closest to the patient— the family or primary care physician—who carries most of the burden. It is often helpful for the primary physician to see the patient at regular intervals, even —or especially— in the absence of new complaints, so that new symptoms do not become necessary as tickets of admission to the doctor's office. The subspecialist then serves as a support and a "backup," offering occasional supplementary specialty examinations while echoing and underscoring the primary doctor's sympathetic encouragement. The importance of this support in avoiding expensive and potentially injurious reexaminations and procedures cannot be overestimated.^

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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