Problem solved: How do you handle patients who have somatic symptom disorder or illness anxiety disorder?

Listen, then reassure I would never call the appointments these patients book unnecessary. I take their symptoms seriously and explain why they are unlikely to progress into something known, bad or treatable. I also make it clear that I will gladly re-evaluate if things change. I normalize uncertainty, and sometimes order tests to rule out bad things while emphasizing that the tests are unlikely to be helpful. I let the patient know that the results are reassuring. If nothing changes, I don’t keep ordering tests. I deal with the anxiety as well as the symptoms. Fixed appointments I have a few patients with illness anxiety disorder, two in particular with severe cases. These two patients have cost the healthcare system thousands of dollars as a result of their repeated visits to our clinic, the emergency room, and other walk-in clinics for nothing more than reassurance. It became difficult for me to accommodate them when I was busy. Three years ago, I decided to treat them differently by giving them short monthly appointments. This method has worked miraculously well, to the extent that one of them has not visited another clinic since. Both patients stated that these fixed appointments put them at ease, make them feel safe and give them time to prepare lists of anxious thoughts beforehand. Acknowledge suffering Instead of jumping to reassurance, I focus on validating what the person is sharing and acknowledging their suffering. Reassurance rarely works if a person doesn’t feel seen, heard and at least somewhat understood. When someone comes to us with a physical phenomenon, it is imperative that we perform a physical examination and be transparent about how we’ve settled on our tentative diagnosis. These days, I try to keep in mind that reassurance is the same as dismissal unless the suffering has been seen and respected, and the person’s fears acknowledged. With that in mind, I think of psychologist Karen Treisman’s suggestion that “every interaction is an intervention” and that it is important to connect before we try to correct. Practice being ‘aware’ At the outset, I discuss working with both mind and body. I focus on “grounding” and anxiety reduction, through simple breathing practices and acronyms. One such acronym is “AWARE,” from Aaron Beck and Gary Emery. In a nutshell, “AWARE” is as follows: Accept that anxiety is happening (A), watch the wave of anxiety as it rises and falls (W), act as if the anxiety were not so high (A), repeat the first three steps (R), and expect both the best and that anxiety will come and go (E). I tell the patient that it’s normal to feel anxiety and I am glad to help with that part of their experience.

Problem solved: How do you handle patients who have somatic symptom disorder or illness anxiety disorder?

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