A 40-year-old woman is admitted to the psychiatric unit of the hospital after ruling out a medical cause for her persistent complaints of headache, fatigue, and difficulty in swallowing. The patient says to the nurse, "The doctor doesn't believe me when I say I am sick. He doesn't know that the tests don't show everything." The nurse should use which of these approaches in responding to the patient?
Explanation
• The therapeutic response involves a continued acceptance of the patient’s opinion rather than an attempt to convince her to abandon it.
• The patient’s somatic symptoms in the absence of a physical basis are consistent with the diagnosis of somatic symptom disorder. The nurse should understand that the patient's symptoms are real to her and she is not making them up. This disorder differs from malingering in that the patient is not fabricating symptoms for personal gain- she believes they are real and experiences them as real.
• As the patient continues to cling to the physiological basis of her somatic complaints, she may challenge the competence of the medical staff or the accuracy of diagnostic tests. The nurse should understand that this behavior is evidence of the difficulty the patient has in giving up her defenses against anxiety.