Psychosomatic Medicine

Psychosomatic (ψυχή - soul and σῶμα - body), psychosomatic medicine is a field of medical (clinical) psychology that studies the influence of psychological factors on the creation, flow, and outcome of somatic (body) diseases.

Representatives of psychosomatic medicine estimate that in the 21st century, about half of diseases are psychogenic in nature. Psychological factors not only provoke some diseases, but also affect the flow of many diseases.

In a popular social erroneous belief that all human diseases are caused by psychological disorders arising in the soul, in the subconscious, in the thoughts of the person. The notion that every illness has its own mystical (symbolic) cause is a common misconception.

Somatic diseases

Somatic diseases caused by psychogenic factors are called "psychosomatic disorders". Human medicine also explores the effects of somatic diseases on the psyche. Specialists of evidence-based medicine under psychosomatic disorders mean diseases that have arisen or worsened against stress.

Psychosomatic illnesses

Psychosomatic illnesses are a group of diseases, the causes of which are problems in the nervous system of the patient with symptoms similar to the diseases of internal organs. These are functional gastric dyspepsia, irritable bowel syndrome and some other gastrointestinal disorders, fibromyalgia, hyperventilation syndrome and many others.

Hypochondria, dysmorphobia (aversion to one's own body), psychogenic itching, psychogenic back pain, psychogenic headache, some forms of diarrhea, hiccups, frequent urination and some other disorders refer to somatoform disorders according to ICD-10 classification, a feature of these conditions is that instrumental methods do not diagnose body disorders.

Psychosomatic diseases and somatoform disorders have similar symptoms.

The ICD-10 definition of somatoform disorders (F45) describes that they present with similar symptoms to those of somatic illness, but differs from psychosomatic illness by the necessary presence of excessive anxiety about personal physical health. Somatoform disorders differ from psychosomatic disorders in that they are not confirmed by diagnosis and examination by instrumental methods, whereas psychosomatic disorders cause measurable symptoms.

"Psychosomatic medicine...studies the interaction of biological, psychological, and social factors in regulating the balance between health and disease"

- Fava G.A., 2017

"Stress is the unspecific response of the organism to any challenge presented to it," Hans Selye wrote in a paper entitled "The Stress of Life"

- Selye H., 1956

If the body copes with the consequences of stress and the result is the mobilization of its defenses, there is a "positive stress" (eustress). If the body is unable to cope with stress, human health deteriorates and the situation can lead to serious illness. Such a state, associated with a depletion of the body's adaptive capabilities and easy vulnerability to adverse influences, including infections and viruses, is called "negative stress". Selye designated this condition as "distress".

Allostasis

In order to build predictions of the development of various diseases taking into account the effect of "accumulation" of stressors of different intensity during life (McEwen, Stellar, 1993; McEwen, Seeman, 1999), the concept of allostatic load was proposed. Allostasis, the ability to achieve stability through change, means the ability of autonomic nervous, endocrine (hypothalamic-pituitary-adrenal axis), cardiovascular and immune systems to respond to internal and external stresses. Excessive allostatic load (distress) leads to pathological conditions caused by chronic hyperactivity or insufficient activity of allostatic systems. Thus, if there is no recovery from the stress factor, allostatic load increases, and the ability to recover (on the mental, somatic and autonomic levels) decreases, which gradually leads to the development of various diseases - diseases of psychosomatic nature.

Think about it! Scientific researches say that about every third sick person has pathological symptomatology of internal organs, which is caused by violation of psychological adaptation!

Today, clinical psychologists use the Diagnostic Criteria for Psychosomatic Research - DCPR - for psychosomatic research. According to the DCPR, psychosomatic illnesses are predisposed to personality traits such as C-type behavior, which is characterized by repression of negative emotions, avoidance of conflicts and stress, the desire to rely solely on himself, with hidden dependence on others (in modern society about 40% of such people) and alexithymia (inability to understand own emotions, to express them).

Bodily psychosomatic manifestations

In 30% of patients examined as outpatients with headaches, abdominal pain, chest pain, back pain, weakness, coughing, dizziness, the origin of bodily disorders is explained by psychiatric abnormalities (Bain S.T., Spaulding W.B., 1967).

In 72% of patients with a psychiatric diagnosis noted at least one somatic symptom (Schurman R.A. et al., 1985). At the same time, about half of mental illnesses manifested by physical disorders are not recognized (Korranyi E.K., 1980).

One of the most frequent causes of somatization is depression: 75% of depressed patients turn to medical institutions, complaining in the majority of cases not about mental, but about somatic disorders (Katon W., 1986).

I used my years of clinical experience and these scientific sources of information to create this article:

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Correll C.U., Kratochvil C.J., March J.S. (2011) Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics. J. Clin. Psychiatry, 72(5): 655–670.

Fava G.А., Cosci F., Sonino N. (2017) Current Psychosomatic Practice. Psychother. Psychosom., 86: 13–30.

Gambarana C., Tolu P.L., Masi F. (2001) A study of the antidepressant activity of Hypericum perforatum on animal models. Pharmacopsychiatry, 34: 42–44.

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Koranyi E.K. (1980) Somatic illness in psychiatric patients. Psychosomatics, 21(11): 887–891.

Lloyd C.E., Nouwen A., Sartorius N. et al. (2018) Prevalence and correlates of depressive disorders in people with type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries. Diabet Med., 35(6):760–769.

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Ng Q.X., Venkatanarayanan N., Ho C.Y. (2017) Clinical use of Hypericum perforatum (St. John’s wort) in depression: a meta-analysis. J. Affect. Disord., 210: 211–221.

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Selye H. (1956) The Stress of Life. McGraw-Hill, New York.

Steger W. (1985) Depressions: a randomized double blind study to compare the efficaciousness of a combination of plant derived extracts with a synthetic antidepressant. Ther. Erfahrungen., 61: 914–918.

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WHO (2012) Adolescent mental health: mapping actions of nongovernmental organizations and other international development organizations. Geneva.

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