Indications for Consultation or Joint Care

Making the initial diagnosis of somatization disorder may require consultation with a psychiatrist to confirm the diagnosis, which lowers the physician's anxiety about missing some esoteric diagnosis and facilitates adherence to appropriate management guidelines. Consultation or joint care also may be indicated by patient complaints about specific subspecialty problems that fall into three categories: psychiatric aspects of the disorder, specific chronic conditions, and diagnostic questions. When other comorbid psychiatric conditions, such as major depression, are present, joint care with a psychiatrist facilitates appropriate, prompt treatment.

Specific chronic conditions may require joint care of the patient with a subspecialist. The subspecialist, of course, must be informed about the patient's somatization disorder and must be willing to cooperate with a jointly administered, conservative management plan. Subspecialist colleagues must be alerted to the somatization disorder patient's predisposition to develop symptoms and complain about them profusely. An uninformed subspecialist would naturally believe that the referring physician wants a symptom thoroughly evaluated and aggressively treated. But because the symptoms of somatization disorder do not improve, enlisting the subspecialist's collaboration can reduce health care use, strengthen a conservative management approach, and avoid frustrating the cooperating physicians.