SHAFT is an acronym for:
Sad (S)
Hostile (H)
Anxious (A)
Frustrating (F)
Tenacious (T)
Clinical features:
(1) the patient has a chronic wound or lesion on the upper extremity, often the hand
(2) there is an absence of objective findings for known disease processes (vasculopathy, etc)
(3) the patient shows a disproportionate self-characterization and verbalization of symptoms, with an eagerness to undergo surgery
(4) history of crying with pain
(5) family history of disability
(6) history of abuse
(7) history of being out of work
The patient complains of pain, numbness, stiffness, and/or paralysis, but the history and physical exam do not match the complaints.
A number of psychological problems may be identified once a psychiatric evaluation is performed. The patient may show little insight into the psychological issues, often with poor response to psychiatric interventions.
Consequences:
(1) the patient often sees multiple physicians at multiple hospitals
(2) the patient may request and receive multiple surgeries
(3) the patient may sabotage skin grafts or the operative site, resulting in delayed healing that cannot be explained
