[Misdiagnosis of psychosomatic disorders]

Considering the frequency with which the diagnosis 'psychosomatic illness' is established, it is puzzling how little attention has been paid to its differential diagnosis. The reason for this may be found not only in the difficulties with which that diagnosis is made but also in the doctor's view of the world and his or her understanding of illness in general. If the doctor only believes in what can be measured and weighed as being real, all symptoms for which no identifiable cause can be found must be considered as imaginary and 'all in the patient's head'. Most contemporary theories about the origin of psychosomatic illness are based on Freud's speculations, established at the beginning of this century. The are deeply rooted in the mechanistic, reductionistic and monocausalitic theories typical for his time. They suggested that the metamorphosis from thought-processes to somatic symptoms begin with a rather mysterious 'jump', taking place in the unconscious of the patient and thus remaining unknown to him. Today we know that all illness has a multifactorial basis and does not develop in a straight line but as a cybernetic loop. Psychosocial factors play as much a role as biological ones. Diagnosis by exclusion (no clear physical findings) or through dualistic thinking (the cause must be either psychological or physical) are, after inadequate knowledge of somatic or psychological medicine, the most common source of the erroneous diagnosis of psychosomatic illnesses. To avoid this, a psychosomatic perspective is needed, an outlook which is based on a holistic understanding of man in health and sickness.(ABSTRACT TRUNCATED AT 250 WORDS)