psychosomatic disorder

                                  Psychosomatic disorder

Psychosomatic means mind (psyche) and body (soma). A psychosomatic disorder is a disease which involves both mind and body. Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety. Your current mental state can affect how bad a physical disease is at any given time.

Which diseases are psychosomatic?

To an extent, most diseases are psychosomatic - involving both mind and body.

There is a mental aspect to every physical disease. How we react to and cope with disease varies greatly from person to person. For example, the rash of psoriasis may not bother some people very much. However, the rash covering the same parts of the body in someone else may make them feel depressed and more ill.

There can be physical effects from mental illness. For example, with some mental illnesses you may not eat, or take care of yourself, very well which can cause physical problems.

However, the term psychosomatic disorder is mainly used to mean ... "a physical disease that is thought to be caused, or made worse, by mental factors".

Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety. For example, psoriasis, eczema, stomach ulcers, high blood pressure and heart disease. It is thought that the actual physical part of the illness (the extent of a rash, the level of the blood pressure, etc) can be affected by mental factors. This is difficult to prove. However, many people with these and other physical diseases say that their current mental state can affect how bad their physical disease is at any given time.

Some people also use the term psychosomatic disorder when mental factors cause physical symptoms but where there is no physical disease. For example, a chest pain may be caused by stress and no physical disease can be found. Physical symptoms that are caused by mental factors are discussed further in another leaflet called Somatisation/Somatoform Disorders.

How can the mind affect physical diseases?

It is well known that the mind can cause physical symptoms. For example, when we are afraid or anxious we may develop:

A fast heart rate

A thumping heart (palpitations)

Feeling sick (nauseated)

Shaking (tremor)

Sweating

Dry mouth

Chest pain

Headaches

A knot in the stomach

Fast breathing

These physical symptoms are due to increased activity of nervous impulses sent from the brain to various parts of the body and to the release of adrenaline (epinephrine) into the bloodstream when we are anxious.

However, the exact way that the mind can cause certain other symptoms is not clear. Also, how the mind can affect actual physical diseases (rashes, blood pressure, etc) is not clear. It may have something to do with nervous impulses going to the body, which we do not fully understand. There is also some evidence that the brain may be able to affect certain cells of the immune system, which is involved in various physical diseases.

What are the treatments for psychosomatic disorders?

Each disease has its own treatment options. For physical diseases, physical treatments such as medication or operations are usually the most important. However, healthcare workers will usually try to treat a person as a whole and take into account mental and social factors which may be contributing to a disease. Therefore, treatments to ease stress, anxiety, depression, etc, may help if they are thought to be contributing to your physical disease.

Psychosomatic disorder, also called Psychophysiologic Disorder,  condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress. It is a condition of dysfunction or structural damage in bodily organs through inappropriate activation of the involuntary nervous system and the glands of internal secretion. Thus, the psychosomatic symptom emerges as a physiological concomitant of an emotional state. In a state of rage, for example, the angry person’s blood pressure is likely to be elevated and his pulse and respiratory rate to be increased. When the anger passes, the heightened physiologic processes usually subside. If the person has a persistent inhibited aggression (chronic rage), however, which he is unable to express overtly, the emotional state remains unchanged, though unexpressed in the overt behaviour, and the physiological symptoms associated with the angry state persist. With time, such a person becomes aware of the physiological dysfunction. Very often he develops concern over the resulting physical signs and symptoms, but he denies or is unaware of the emotions that have evoked the symptoms.

Psychosomatic disorders may affect almost any part of the body, though they are usually found in systems not under voluntary control. Research by psychiatrist Franz Alexander and his colleagues at the Chicago Institute of Psychoanalysis in the 1950s and 1960s suggested that specific personality traits and specific conflicts may create particular psychosomatic illnesses, but it is generally believed that the form a disorder takes is due to individual vulnerabilities. Emotional stress is assumed to aggravate existing illnesses, and there is some evidence that it may precipitate illnesses not usually considered to be psychosomatic (e.g., cancer, diabetes) in individuals predisposed to them.

Psychosomatic disorders resulting from stress may include hypertension, respiratory ailments, gastrointestinal disturbances, migraine and tension headaches, pelvic pain, impotence, frigidity, dermatitis, and ulcers.

Many patients suffering from psychosomatic diseases respond to a combination of drug therapy, psychoanalysis, and behaviour therapy. In less severe cases, patients can learn to manage stress without drugs.

Psychosomatic medicine

Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, and behavioral factors on bodily processes and quality of life in humans and animals.

The academic forebear of the modern field of behavioral medicine and a part of the practice of consultation-liaison psychiatry, psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties including psychiatry, psychology, neurology, internal medicine, surgery, allergy, dermatology and psychoneuroimmunology. Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence.

History of psychosomatics.

In the medieval Islamic world the Persian psychologist-physicians Ahmed ibn Sahl al-Balkhi (d. 934) and Haly Abbas (d. 994) developed an early understanding of illness that was due to the interaction of the mind and the body. They realized how a patient's physiology and psychology can have an effect on one another. They found correlations between patients who were physically and mentally healthy and between those who were physically and mentally ill.

In the beginnings of the 20th century, Franz Alexander led the movement looking for the dynamic interrelation between mind and body. Sigmund Freud pursued a deep interest in psychosomatic illnesses following his correspondence with Georg Groddeck who was, at the time, researching the possibility of treating physical disorders through psychological processes.

Since the 1970s, due to the work of Thure von Uexküll and his colleagues in Germany and elsewhere, biosemiotic theory has been used as a theoretical basis for psychosomatic medicine. Particularly, the umwelt concept and the theory of organism by Jakob von Uexküll has been found useful as an approach to describe psychosomatic phenomena.

Psychosomatic disorders.

Some physical diseases are believed to have a mental component derived from the stresses and strains of everyday living. This is the case, for example, of lower back pain and high blood pressure, which appear to be partly related to stresses in everyday life. Psychiatry has found it difficult until relatively recently to distinguish somatoform disorders, disorders in which mental factors are the sole cause of a physical illness, from psychosomatic disorders, disorders in which mental factors play a significant role in the development, expression, or resolution of a physical illness.

For instance, while peptic ulcer was once thought of as being purely caused by stress, later research revealed that Helicobacter pylori caused 80% of ulcers. However 4 out of 5 people colonised with Helicobacter pylori do not develop ulcers, and an expert panel convened by the Academy of Behavioral Medicine Research concluded that ulcers are not merely an infectious disease and that mental factors do play a significant role. One likelihood is that stress diverts energy away from the immune system, thereby stress promotes Helicobacter pylori infection in the body.

It is still difficult to classify some disorders as purely physical, mixed psychosomatic, or purely somatoform. One example is Irritable Bowel Syndrome (IBS) that was considered formerly as having purely mental causes, while subsequent research showed significant differences in the behaviour of the gut in IBS patients. On the other hand, there are no actual structural changes in IBS patients and research shows that stress and emotions are still significant factors in causing IBS.

However, while it is necessary to identify if an illness has a physical basis, it is recognized more and more that the effort to identify disorders as purely physical or mixed psychosomatic is increasingly obsolete as almost all physical illness have mental factors that determine their onset, presentation, maintenance, susceptibility to treatment, and resolution.

Addressing such factors is the remit of the applied field of behavioral medicine. In modern society, psychosomatic aspects of illness are often attributed to stress making the remediation of stress one important factor in the development, treatment, and prevention of psychosomatic illness.

Connotations of the term "psychosomatic illness"

Psychosomatic medicine is not to be confused with the demotic and scientifically incorrect use of the phrase "psychosomatic illness," particularly the influence the mind has over physical processes — including the manifestations of disabilities that are based on intellectual infirmities, rather than actual injuries or physical limitations. These are exemplified by phrases such as the power of suggestion, the use of "positive thinking" and concepts like "mind over matter" to apply to illnesses that are now called somatoform disorders. Such illness is classified as neurotic, stress-related and somatoform disorders by the World Health Organization in the International Statistical Classification of Diseases and Related Health Problems. The field of psychosomatic medicine fell into disrepute clinically due to this incorrect use of this term, which was largely due to the influence of psychoanalytic theory on psychiatric physicians and the inaccurate application by non-specialists in the first part of the 20th century who considered this form of illness to be akin to malingering, thereby further harming the sufferer.For this reason, among others, the field of Behavioral Medicine has taken over much of the remit of Psychosomatic Medicine in practice and there exist large areas of overlap in the scientific research.

Treatment.

Psychosomatic medicine is considered a subspecialty of the fields of psychiatry and neurology. Medical treatments and psychotherapy are used to treat psychosomatic disorders.