Depression may be missed in patients who "normalise" their symptoms

How patients think about their common bodily symptoms may affect the tendency of general practitioners to detect depression or anxiety. Kessler et al (p 436) asked general practice patients to complete questionnaires that rated them for psychological distress and also characterised their thinking about common symptoms into three categories: somatising, psychologising, and normalising (this last being a tendency to minimise and externalise symptoms). Normalising was the most common attribution, and, in contrast with psychologising or somatising, is non-pathological in nature. Whereas "psychologisers" were highly likely to receive a diagnosis of depression or anxiety, "normalisers" proved difficult for the general practitioners to diagnose, irrespective of their rating for psychological distress. Somatising had no effect in this study.


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Relevant Article

Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care • Commentary: There must be limits to the medicalisation of human distress

David Kessler, Keith Lloyd, Glyn Lewis, Dennis Pereira Gray, and Iona Heath
BMJ 1999 318: 436-440. [Abstract] [Full Text] [PDF]