PT  - JOURNAL ARTICLE
AU  - Edward A. Walker
AU  - Jürgen Unützer
AU  - Wayne J. Katon
TI  - Understanding and Caring for the Distressed Patient With Multiple Medically Unexplained Symptoms
AID  - 10.3122/15572625-11-5-347
DP  - 1998 Sep 01
TA  - The Journal of the American Board of Family
                Practice
PG  - 347--356
VI  - 11
IP  - 5
4099  - http://www.jabfm.org/content/11/5/347.short
4100  - http://www.jabfm.org/content/11/5/347.full
SO  - J Am Board Fam Med1998 Sep 01; 11
AB  - Background: Although physicians commonly encounter patients with complicated medical problems, some have a mix of unexplained medical symptoms and distress that can seem overwhelming to patient and physician alike. Methods: We describe a model for thinking about and helping these complex patients. The model was developed from our personal clinical experience as primary care psychiatric consultants, as well as from a review of the literature using such key words as “difficult,” “frustrating,” and “somatization.” Results: The model involves understanding predisposing factors that render the patient vulnerable to the development of a disabling condition, precipitating factors that initiate an episode of illness, and perpetuating factors that maintain maladaptive illness behaviors with time. Conclusions: Awareness of these factors allows the clinician not only to tolerate and gradually unravel the complicated interactions that create and sustain distress in patients with multiple medically unexplained symptoms, but also devise practical and effective management strategies for these complex patients.