Psychological processes postulated to be involved in
somatisation disorders
- Conversion
- the relief produced by converting psychological distress into physical
symptomatology is termed
"primary gain"
- Eliciting of care, attention and medical treatment
- adoption of the sick role may produce benefits termed "secondary gain"
- some patients may seek apparently undesirable interventions
- patients may be dissatisfied because their real needs are unmet, or because
demonstrating the inadequacy of their care is the purpose of the exercise
- Difficulty in recognising or expressing psychological distress
- alexithymia, "denial of affect" and use of physical metaphor may
relate to individual history and cultural factors
- the degree of resistance to psychological formulation varies
considerably
- Attentional factors
- the more physical sensations are attended to, the more they are
experienced as intrusive, unpleasant and abnormal
- Raising the stakes
- the more that a patient has invested in, or lost to, the sick
role the harder it may be to abandon it
- if the patient suspects that their illness is not taken
seriously they may present increasingly severe symptoms in order
to produce inappropriate "disease affirmation"