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clinmed/2001010003v1 (March 5, 2001)
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Psychosocial factors in chronic disability
The person presenting the picture of a so-called chronic disability syndromes is either a patient or medicolegal claimant. He/she is apparently disabled by somatic and less often psychological complaints that are, despite investigation, without adequate medical explanation. He has severe limitations in the activities of daily living, recreation, sports, and the ability to perform their normal work. Chronic pain and tiredness are the most common elements. Psychological illnesses are frequently invoked and are often a genuine source of suffering and disability. However, patients who may be rewarded by large financial settlements in courts, may also on occasion exaggerate their claims. This paper attempts to examine the possible mechanisms of these symptoms. The growing number of patients with chronic disability syndromes pose serious problems. They are a burden on medical resources; many follow personal injuries and consume time and huge expenses in hearings in civil courts . Health professions commonly assume that these are all genuine cases, which many are. This paper argues that there is a danger of blindly accepting the authenticity of all such claims, and of providing a medical diagnosis that would not bear serious consideration in non-litigation clinical work; such diagnoses also ignore the imperative of financial reward. This affords it a social and legal acceptability, which is not always justified by logical and scientific evidence.