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Somatization and Medicalization FREE

Roderic H. Fabian, MD; Hans A. Langsjoen, MD; Thomas A. Kent, MD
[+] Author Affiliations

Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.


JAMA. 1996;275(18):1398-1398. doi:10.1001/jama.1996.03530420026018
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To the Editor.  —The article by Drs Barsky and Borus1 on somatization was timely, but certain issues need discussion. First, the authors overrate the role of psychiatrists in treating somatization. They cite Smith et al,2,3 who show that a psychiatric consult intervention of a specific type is helpful in reducing health care costs among patients with somatization syndrome or somatization disorder, but then Barsky and Borus recommend a psychiatric management approach opposite to that of Smith et al in asserting that patients should be "taught about the process of somatization" and that cognitive and behavioral therapy should be used. Although the recommendations of Barsky and Borus are based in part on speculation that "medicalization fosters somatization," there is no evidence that medicalization causes or reinforces somatization or contributes significantly to health care costs. The cause of somatization is, in fact, not known. In the studies by Smith et

REFERENCES

Barsky AJ, Borus JF.  Somatization and medicalization in the era of managed care. JAMA . 1995;;274:1931-1934.
Smith GR Jr, Monson RA, Ray DC.  Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med . 1986;;314:1407-1413.
Smith GR Jr, Rost K, Kashner TM.  A trial of the effect of standardized psychiatric consultation on health outcomes in costs in somatizing patients. Arch Gen Psychiatry . 1995;;52:238-243.
Hellman CJC, Budd M, Borysenko J, McClelland DC, Benson H.  A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behav Med . 1990;;16:165-173.
Smith GR Jr.  The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization or pain. Gen Hosp Psychiatry . 1992;;14:265-272.
Goodwin DW, Guze SB. Psychiatric Diagnosis . 4th ed. New York, NY: Oxford University Press Inc; 1989;:103-124.

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Barsky AJ, Borus JF.  Somatization and medicalization in the era of managed care. JAMA . 1995;;274:1931-1934.
Smith GR Jr, Monson RA, Ray DC.  Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med . 1986;;314:1407-1413.
Smith GR Jr, Rost K, Kashner TM.  A trial of the effect of standardized psychiatric consultation on health outcomes in costs in somatizing patients. Arch Gen Psychiatry . 1995;;52:238-243.
Hellman CJC, Budd M, Borysenko J, McClelland DC, Benson H.  A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behav Med . 1990;;16:165-173.
Smith GR Jr.  The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization or pain. Gen Hosp Psychiatry . 1992;;14:265-272.
Goodwin DW, Guze SB. Psychiatric Diagnosis . 4th ed. New York, NY: Oxford University Press Inc; 1989;:103-124.
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