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Somatization and Medicalization-Reply

Arthur J. Barsky, MD; Jonathan F. Borus, MD
JAMA. 1996;275(18):1399. doi:10.1001/jama.1996.03530420026021.
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In Reply.  —Somatization is a multidetermined phenomenon and represents the product of psychological, behavioral, interpersonal, and social factors. Therefore, effective treatment is often complex and multimodal. While the primary care physician is undoubtedly the cornerstone of therapy, he or she alone may not be sufficient. Primary care physicians can care more effectively for somatizing patients with the assistance of management guidelines, psychiatric consultation, and specific training and educational programs, as Smith et al1 have shown using psychiatric consultation letters. However, more definitive symptom relief and improved functional status may require a more intensive targeted effort, which requires the time and expertise the primary care physician lacks. Contrary to Drs Fabian, Langsjoen, and Kent, we find impressive evidence of the efficacy and effectiveness of cognitive and behavioral techniques in a variety of conditions, including isolated functional somatic symptoms, somatization disorder, and hypochondriasis.2 6 Although it is true that nonspecific


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