An attachment perspective on understanding and managing medically unexplained symptoms
Simon is a 37-year-old teacher. He has been referred for psychiatric assessment by his family doctor after three referrals to specialists (gastroenterologist, cardiologist and neurologist) have produced no explanation for a cluster of symptoms, including chest and epigastric pain, intermittent ‘pins and needles’ in both hands, and diarrhoea. The symptoms have persisted for six months and have been severe enough that he has recently taken a leave of absence from work. He is embarrassed and a little angry that his doctor suggested seeing a psychiatrist, as it is clear that the symptoms ‘are real, not just in my head’. His doctor suggested that the symptoms might be due to stress, but Simon notes that he has had a career that is stressful but satisfying for many years without it causing a problem like this. There do not appear to be any obvious changes in his life preceding the onset of pain and the subsequent emergence of diarrhoea and peripheral parasthesia.