title: Understanding and caring for the distressed patient with multiple medically unexplained symptoms.
abstract: BACKGROUND
  Although physicians commonly encounter patients with complicated medical problems, some have a mix of unexplained medical symptoms and distress that can seem overwhelming to patient and physician alike.
  
  
  METHODS
  We describe a model for thinking about and helping these complex patients. The model was developed from our personal clinical experience as primary care psychiatric consultants, as well as from a review of the literature using such key words as "difficult," "frustrating," and "somatization."
  
  
  RESULTS
  The model involves understanding predisposing factors that render the patient vulnerable to the development of a disabling condition, precipitating factors that initiate an episode of illness, and perpetuating factors that maintain maladaptive illness behaviors with time.
  
  
  CONCLUSIONS
  Awareness of these factors allows the clinician not only to tolerate and gradually unravel the complicated interactions that create and sustain distress in patients with multiple medically unexplained symptoms, but also devise practical and effective management strategies for these complex patients.
authors.affiliation: Department of Psychiatry, University of Washington Medical School, Seattle 98195, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Walker
authors.forename: J
authors.initials: J
authors.lastname: Unützer
authors.forename: W J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000328:Adult; D003863:Depression / Q000150:complications; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D008962:Models, Theoretical; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013001:Somatoform Disorders; D013315:Stress, Psychological