Somatic fixation in patients and physicians: A biopsychosocial approach.

Abstract

Somatic fixation occurs when the patient or physician focuses exclusively on the somatic aspects of a complex problem. This common and challenging problem results from individual, family, and cultural factors that promote communication and the expression of emotional experience through somatic symptoms. An unrewarding cycle of interactions occurs when the physician first rules out organic illness in the somatically fixated patient and then searches for psychosocial explanations. This article presents a biopsychosocial approach to somatic fixation in which the physician or a treatment team establishes a collaborative relationship with the patient system and strives to reach a mutually acceptable explanation for the symptoms. Biomedical and psychosocial evaluations are integrated from the beginning, and the patient's somatic defenses and mode of communicating are respected. Limited goals are established and levels of patient functioning, rather than symptoms, are monitored. Collaborating with another physician or a family therapist is often helpful in making work with these difficult cases more successful and more enjoyable. A difficult case of a somatically fixated couple is presented.