Some underlying concepts..

There is wide variation in our ability to perceive sensations. This is important in our ability to perceive pain and other sensations arising from within our body. Some people are able to perceive peristalsis and other internal movements at a very low threshold. Ability to endure pain also shows wide variation. It also depends on our subjective mental state and contextual factors (e.g.: being lonely in a strange hospital or being surrounded by one’s close kith and kin).

Illness behavior: A person’s belief about presence or absence of illness in him. It can be abnormal when an ill person denies having illness or a healthy person misperceives himself as ill.

Sick Role: It is the privilege given by the society to a person found to be sick by appropriate specialists. The sick person is temporarily exempted from work and other responsibilities. In turn he is expected to subject himself to medical examinations and comply with treatments prescribed. When he is declared as relieved he is expected to abandon sick role and return back.
Clinical picture
14 symptoms are the cause of 50% of medical attendance in general practice. Only 10 to 15% of these are found to be having an organic basis over a period of one year follow up. The rest of them continue to seek medical help without benefit. They sometimes frustrate and irritate the doctors and give rise to arguments. They are a potential source for legal battles. A lot of money is squandered by them and they are at risk of iatrogenic complications from medical investigations and surgical procedures.

The common symptoms are
1) Abdominal pain.
2) Headache.
3) Chest pain / tightness in chest
4) Palpitations
5) Breathing difficulty
6) Low back ache.
7) Vague aches and pains / fibromyalgia.
8) Dyspepsia
9) Dizziness / tinnitus.
10) Vaginal discharge
11) Pelvic pain / premenstrual syndrome.
12) Alterations in bowel habits.
13) Fatigue
14) Sleep disturbance.

Symptoms are usually of prolonged duration with a waxing and waning course. Multiple consultations including specialist work ups would have drawn a blank.