An angry woman with physical complaints of unknown origin. A case study
summary A general practitioner referred a female patient with physical complains of unknown origin, and pronounced behavior suggestive of a very sick person, to a psychiatrist, after she expressed suicidal ideation. The psychiatrist approached the patient and her family in a structured, directive fashion, which was congruent with his not having a medical explanation for her complaints. A treatment contract was made in which regular appointments played a central role. The option of referring her to a somatic specialist was handled in a strategic way. This approach led to reduced consumption of medicine and is appropriate for use by a general practitioner who is in consultation with a psychiatrist.