Walsh & Hoyt: General Considerations

Several issues are addressed in order to better define nonorganic disease. These issues include the nature of the symptom or symptoms, the somatic or physical aspect of the disorder, the ideation and affect of the patient, the patients attitude toward those trying to diagnose and treat the condition, and the patients motivation. The nature of the symptom and the manner of its communication are crucial in the understanding of a nonorganic disorder. The patient may be stoic and restrained, or histrionic and dramatizing. The symptom may take the form of a physical dysfunction (e.g., strabismus) that is displayed with a minimum of verbal description, or the symptom may be described verbally during the examination. Thus, one must also determine the nature of the physical dysfunction and the degree of disability. It is important to determine why the symptoms have focused in a particular area (e.g., the visual system).