The somatically preoccupied patient in primary care: use of attachment theory to strengthen physician-patient relationships

Abstract

Background: Individuals with somatic preoccupation constitute a substantial number of primary care patients. Somatically preoccupied patients are challenging to primary care physicians for several reasons including patient complaints consuming a great deal of physician time, expense to diagnose and treat and strain on the physician-patient relationship. This paper examines and discusses how disruptions in early attachment relationships such as often occurs when a female is a victim of child sexual abuse may result in somatic preoccupation in adulthood. Treatment utilizing attachment theory:Attachment theory provides a useful framework for primary care physicians to conceptualize somatic preoccupation. Utilization and containment techniques grounded in an understanding of attachment dynamics aid the physician in developing a sound physician-patient relationship. Successfully engaging the patient in treatment prevents misunderstandings that frequently derail medical care for somatically preoccupied patients.

Exploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia

“…It may also be that transference /countertransference issues are a major factor in GPs becoming more or less active in assisting such patients. Our results revealed that whilst GPs were very frustrated in their attempts to provide care to patients with BPD, and were aware of issues of transference and countertransference, they also perceived few supports available to them from more specialist mental health service providers to improve their circumstances, which is similar to the findings of others [39]. Without such support, GPs were left with feelings of apprehension, dismay, and even disempowerment, as evidenced by their description of these as “heart sink” patients.…”

“…The recognition of somatisation may be a vital element of the GPs’ skill set that could go a long way in mitigating the challenges they face during presentations involving BPD. Studies have revealed that individuals who experience somatisation are highly represented among patients utilising primary care, and that there is a significant relationship between somatisation and BPD [37,39]. These findings further suggest that GPs may benefit from establishing a BPD diagnosis, understanding relevant management, and taking note of how somatisation figures into presentations.…”

The conduct and process of mental capacity assessments in home health care settings

“…The community practitioner-patient relationship lends itself to establishing long term and more interpersonally connected relationships (Miller, 2008).…”

The Rivers Centre in Scotland: An Attachment‐Based Service Model for People With Complex Posttraumatic Stress Disorder

“…Early traumatic experiences, it has been argued, can “ravage” the attachment system (Bloom, ) and produce expectations that relationships with caregivers in adulthood will be similar to those of the past in terms of a loss of power, choice, control, and safety. A number of researchers have demonstrated the influence of insecure attachment patterns on relationships in a therapeutic context (Miller, ; Salmon & Young, ), and some have argued that healthcare systems themselves have the potential to retraumatize individuals due to their fundamental operating principles of coercion and control (Bloom & Farragher, ; Conners‐Burrow et al., ).…”