Episode 33: Psychosomatic Illness

Many thanks to Suzanne O’Sullivan for her time in putting this podcast together. Her excellent books “It’s all in your head” and “Brainstorm” are well worth a read.

It is certainly one of the PHEMcast recordings which is going to change my own practice the most.

We can all find these patient’s challenging to look after – we often fail to communicate effectively and meaningfully. This is understandable as so much of our training and experience is based around the treatment of the physical condition.

The key things I took away from this interview were:

• A vast majority of patients with psychosomatic symptoms have no control over their symptoms: even when they are made aware that there is no physical / pathological cause
• By attributing psychosomatic symptoms to physical causes we are doing our patients a huge disservice
• The sooner a psychosomatic cause for symptoms is identified and discussed with the patient the more likely they are to make a recovery
• The misdiagnosis rate of a psychosomatic cause is low
• There are several features of dissociative seizures that can help us distinguish them from true epileptic seizures
• ‘Malingering’ (pretending to be unwell for gain) is extremely rare

There are a huge number of terms to describe psychosomatic illness – some of which are not useful. A common nomenclature here will help communication between both health care professionals and our patients.

Psychosomatic: a physical illness or other condition) caused or aggravated by a mental factor such as internal conflict or stress.

Non-epileptic seizures  = dissociative seizures.

The terms ‘functional’ and ‘supratentorial’ are best avoided!

As always please let us know your thoughts!