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Somatisation: The tendency to experience, conceptualise and communicate mental states and distress as physical symptoms or altered bodily function.

Somatoform disorder: The presence of physical symptoms that suggest but which are not fully explained by a general medical condition, the direct effects of drugs or another mental disorder.³ The symptoms must cause clinically significant distress, or impairment in social, occupational or other areas of functioning. In contrast to factitious disorders and malingering, the physical symptoms are not intentional.

Somatisation disorder: A rare and extreme version of somatoform disorder where the patient over many years seeks medical attention for many physical symptoms with no evidence of organ pathology. The diagnosis of the disorder requires the presence of 14 of 37 potential symptoms for women and 12 for men (Box 3).

Somatisation syndrome: A partial version of somatoform disorder, in which the patient has fewer symptoms (four for men, six for women).

Hypochondriasis: A preoccupation with fears of having, or the idea that one has, a serious disease.⁴ The preoccupation must last at least six months, persist despite appropriate medical evaluation and reassurance and cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Factitious disorder: The intentional production of false or grossly exaggerated symptoms for reasons that are not obvious. It is presumed that there is a psychic need to assume the sick role and to receive care. Patients often present their history with flair or gross exaggeration (pseudologia fantastica), and receive multiple hospitalisations (Munchausen's syndrome). When there are external incentives for the behaviour (e.g., financial gain), malingering should be diagnosed.

Neurasthenia: "Tired nerves" or "nervous exhaustion", now defined as complaints of increased fatigue after mental effort, or bodily weakness after minimal physical effort, combined with unpleasant physical symptoms (dizziness, headaches), worry, irritability and sleep disturbance. The modern neurasthenic will more likely be diagnosed with chronic fatigue syndrome, depression or anxiety.

Sick role: When disease occurs in a previously well individual, that person is granted certain privileges (exemption from work and other responsibilities and the offer of care by family and significant others), but at the same time is expected to accede to certain obligations (to seek appropriate help and to accept the treatment offered in order to get well as soon as possible). Some people seek the privileges of the sick role without accepting the obligations; whether this is malingering or chronic somatisation disorder depends on the degree of conscious voluntary control the person has over their illness behaviour.

Illness behaviour: The way an individual in the "sick role" perceives, evaluates and acts upon symptoms. There is considerable variation in this behaviour. One person may be stoical, another dramatic. One may communicate distress verbally, another physically.

Abnormal illness behaviour: Inappropriate or maladaptive attempts to be granted the benefits of the sick role without meeting the necessary obligations.⁵

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