Psychosomatic disorders

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Psychosomatic disorders

Disorders characterized by physiological changes that originate, at least in part, from emotional factors. The classical psychosomatic symptoms and their theorized causes are shown in the table.

Theorized psychological factors in classical psychosomatic disorders
Symptom (disease) Psychological factors Presumed psychosomatic mechanism
Hyperacidity (peptic ulcer) Inhibited dependence; general stress Increased acid secretion
Essential hypertension Conflict over hostility; general stress Vasoconstriction
Bronchial asthma Conflict over wish for protection or separation; anxiety; general stress Bronchospasm
Migraine Conflict over control; general stress Vasoconstriction and vasodilatation
Thyrotoxicosis (Graves' disease) Conflict over premature self-sufficiency Increased thyroid-stimulating hormone secretion
Diarrhea (ulcerative colitis) Conflict over an obligation Gastrointestinal cholinergic activation

Psychological states influence body organs through a combination of three interrelated mechanisms: neural, hormonal, and immunologic. Voluntary movements (for example, clenching the teeth) are mediated through the motor neurons by the conscious command of the brain. In stress, clenching of the teeth, mediated by the same motor neurons, may also occur, but the act may not be voluntary and conscious. Stress usually causes an activation of the sympathetic nervous system and the hypothalamo-pituitary-adrenal axis followed by a decrease in immunocompetence. Immune mechanisms may be suppressed in part through corticosteroid activation, but a decrease in T-lymphocyte activity in stress may not be mediated by hormones. Individual specific, but inadvertent, conditioning of specific conflict or stress to specific bodily malfunction may be an important psychosomatic mechanism. See Conditioned reflex, Neuroimmunology

Conversion disorders refer to physical symptoms referrable to the somatosensory nervous system or special sensory organs that cannot be explained on the basis of a medical or neurologic disease. Common symptoms include paralysis, blindness, ataxia, aphonia, and numbness of the feet (stocking anesthesia). The symptoms may represent a psychological conflict or may be a form of body-language communication. The treatment of choice is psychotherapy.

In somatization disorder (also known as Briquet's syndrome), the patient recurrently complains of multiple somatic symptoms that are referrable to practically every organ system in the body and which, upon medical investigation, turn out not to be a diagnosable physical disease. This disorder is distinguished from conversion disorder by the chronicity and multiplicity of its symptoms. The symptoms do not usually symbolize psychological conflicts but may represent general dysphoria and distorted illness behavior. There is no definitive treatment; patients should be managed by one physician who coordinates all diagnostic and treatment plans and who provides ongoing support and follow-up without unnecessary invasive procedures.

Specific psychological conflicts often characterize patients with classical psychosomatic symptoms or disorders they represent; however, only one aspect of a multifactorial or heterogeneous disorder is not considered to be etiologic. Genetic factors are known to play important roles in the pathogenesis of most of these diseases. Some of the psychological difficulties demonstrated by these patients may in fact be a result of the disease. Psychotherapy is often helpful in resolving the conflicts when they are severe enough to warrant it, but it does not necessarily ameliorate the physical symptoms or the course of disease. See Psychotherapy

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Dr Rifai delivered the final presentation, which discussed psychosomatic disorders in the medical setting and described the recommended management of these patients.
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