INVITED REVIEW SOMATIC PRESENTATIONS OF PSYCHIATRIC ILLNESS IN PRIMARY CARE SETTING

MUCH of the recent literature on somatisation has been based upon patients with chronic somatisation, or the ‘somatisation disorders’ of DSM-III [l-5]. Although the various surveys have produced many interesting findings, the social psychiatrist is left with nagging doubts. First, it is possible that the patients who form the subject of the various investigations are in fact a highly skewed sample of the larger population of somatising patients in the community. Thus, some of the features attributed to these patients may tell us more about the selection processes that govern referral to the specialist clinics than about the phenomenon of somatisation itself. The second problem is that by the time somatisation has lasted several years we are likely to learn more about factors which perpetuate the disorder, and rather less about the factors which brought the phenomenon about in the first place. We have therefore concentrated our attention on patients attending primary care physicians with new episodes of illness who are found to have a psychiatric disorder according to DSM III criteria at independent interview. The focus of our research is on the factors which determine why one patient will express their distress in the language of somatic symptoms, while others will ‘psychologise’ their distress. In the course of our work we discover that the patients themselves, with their combinations of affective and somatic symptoms, are strikingly similar to descriptions of patients which go back as far as George Cheyne, in 1743.