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J R Soc Med. 2004 October; 97(10): 506–507.
PMCID: PMC1079638

Personality disorder and somatization

Professor Tyrer’s classification of personality disorder into R (treatment-resisting) and S (treatment-seeking) types (August 2004 JRSM1) has utility outside psychiatry—particularly in primary care, where people frequently consult with somatization disorder and simultaneously partake of complementary therapies elsewhere.2

Dimensional ratings may be more reliable than categorical ones, but most general practitioners will be able to recognize the R and S groupings in somatizers, the former anxious to change their environment, and the latter themselves.

When it comes to interventions it may be that, as in psychotherapy,3 doctor/patient factors are as important as the type of therapy used. If a somatizing tendency is a relatively fixed part of personality, people with R(S) and S(S) should select their primary care physicians with care. Perhaps their first and most important task is whether to choose a ‘splitter’ or a ‘lumper’.


1. Tyrer P. New approaches to the diagnosis of psychopathy and personality disorder. J R Soc Med 2004;97: 371–4 [PMC free article] [PubMed]
2. Ernst E, White AR. The BBC survey of complementary medicine use in the UK. Complement Ther Med 2000;8: 32–6 [PubMed]
3. Beutler LE, Machado PP, Neufelt SA. Therapist variables. In: Bergin AR, Garfield SL, eds. Handbook of Psychotherapy and Behaviour Change. New York: Wiley, 2004

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press