Somatization in response to undiagnosed obsessive compulsive disorder in a family

A 63 year-old patient presented to his family physician with recurrent episodes of syncope, weakness and various other somatic symptoms. Lengthy clinical investigations found no organic pathological findings but a brief family assessment by the family physician revealed that the patient's wife was the "hidden" patient. Successful treatment of the patient's wife led to full recovery for both.Exploration and treatment of the family context may often hold the key to the solution of difficult problems in somatizing patients.Family physicians are often faced with patients who present complex or puzzling symptoms that defy diagnosis or explanation despite intensive investigations [1]. Rigid adherence to the biomedical model is unsatisfactory in many cases. In the somatizing patient, one in whom multiple physical complaints suggest physical disorders without a disease or physical basis to account for them, the solution to problems may lie within the family context [2]. The objective of this case presentation is describe a successful family interevention in a patient with long-standing symptoms who was not helped by traditional investigations and treatments directed at the identified patient.Mr. M. was a 63-year-old man of North African origin living in a deprived neighborhood in a city in Northern Israel. He was married and the father of five children. His youngest son, aged 17 years, was still living at home. He had worked in a large construction company, initially as a labourer then later as a manager until his early retirement. He presented to a new family physician in the neighbourhood clinic on a busy day, without an appointment, requesting to be seen urgently. He was known to this family physician from previous visits only for treatment of poorly-controlled Type 2 diabetes mellitus, from which he had suffered for 20 years. The patient was a tall obese, plethoric man. It was not immediately clear to the family physician why the patient, who was usually slow to speak a