Illness Cognition, Symptom Reporting and Somatization in Family Medicine

  • James Robbins
  • Laurence Kirmayer


Biomedical practitioners hope for a simple correspondence between clinical presentation and organic pathology. Unfortunately, illness behaviour supervenes to make the relationship between illness and disease exceedingly complex. Style of symptom presentation interacts with the structure of the health-care system to determine whether patients1 distress is accurately recognized and alleviated. From 20 to 84 percent of patient visits to primary care are for somatic complaints that receive no organic diagnosis (Kellner, 1985). When psychosocial factors are noted as part of their presentations, patients with obscure somatic symptoms may be described as somatizing or hypochondriacal and referred for psychiatric evaluation of “abnormal illness behaviour” (Pilowsky, 1969). When psychosocial factors are not recognized, these patients may be exposed to lengthy diagnostic and therapeutic intervention and, when no organic explanation is forthcoming, casually reassured or abruptly told their problems are imaginary.


Somatic Symptom Cognitive Style Somatic Complaint Symptom Reporting Affective Symptom 
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Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • James Robbins
    • 1
  • Laurence Kirmayer
    • 1
  1. 1.Institute of Community and Family PsychiatryMcGill UniversityUSA

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