PSYCHOSOMATIC DISEASES

Psychosomatic diseases are those medical conditions whose occurrence and/or evolution is influenced by psychological factors.
Psychological trauma can trigger not only mental diseases, but also somatic ones (called psychosomatic diseases); in addition, certain somatic diseases, such as brain tumors, organ failures (hepatic, renal or even respiratory and cardiac failures) may lead to significant mental disorders (even delirium or coma).
Although, in general any condition is influenced even to a small degree by psychological factors, there is a number of conditions for which this psychosomatic relationship is obvious.

Even if some of these diseases are caused by organic or even infectious agents, their occurrence or evolution is still influenced by the mental factor. For example, after it was shown that Helicobacter pilori was involved in the pathogenesis of the gastro-duodenal ulcer, the fact that the psychogenic stress factor triggers a disease in a healthy Helicobacter carrier is accepted, and the personality / stress adaptation factor may explain why only some of the healthy Helicobacter carriers get sick.

Understanding the genesis and persistence of the psychosomatic disease:
In psychosomatic diseases, the genetic and environment factors are involved in an organ vulnerability, pinpointing the target of the psychological factors – stress, negative emotions, stress adaption manner.

Diagnosis criteria for psychosomatic diseases (according to the international diagnostic DSM IV-TR):

A. A somatic medical condition exists (duodenal ulcer etc.)
B. Psychological factors have a negative impact on the general medical condition as follows:
- psychological factors have influenced the evolution of the general medical condition, namely the development, exacerbation or delay of cure of the medical condition;
- the factors interfere with the treatment of the general medical condition;
- the factors represent an additional risk for an individual’s health;
- stress-related physiological responses accelerate or exacerbate the symptoms of the general medical condition.

 

Psychological factors refer to:

  1. A mental disorder which influences a general medical condition (e.g. major depression delays recovery after a heart attack);
  2. Psychological symptoms (anxiety exacerbating asthma etc.);
  3. Personality traits or ways of coping with stress
  4. Maladaptive behaviors (sedentariness, dependencies etc.);
  5. Stress-related response (ulcer, high blood pressure, arrhythmia etc. stress exacerbation)

Onset of psychosomatic conditions

These conditions may occur for the first time during childhood, adolescence (mental anorexia, bronchial asthma, sometimes diabetes, etc.) or adulthood following an intense emotional shock.
In the beginning, the symptoms are reversible, but as they persist, an altered medical condition may occur which weakens the general resistance of the body or affects the functions of certain organs. In general, psychosomatic conditions are centered at the level of certain preferred organs: digestive, respiratory, allergic or cardio-vascular area, etc.

How do we make a difference between the psychosomatic disorder and an organic condition?

Patients with psychosomatic disorders are different from those with somatic conditions in a few basic aspects:

  1. multitude of symptoms (tachycardia, nausea, constipation/diarrhea, shortness of breath, allergic hypersensitivity to different stimuli, weight loss/obesity, bronchial asthma, angina pectoris etc.);
  2. patients are convinced that there is an organic cause despite repeated examinations that do not lead to a diagnosis and often they do not accept a psychological explanation;
  3. sometimes an excessive preoccupation with the personal health and focus on the symptoms
  4. repetitive character of the symptoms;
  5. disease persistence, despite the treatment given by the internist, cardiologist, gastroenterologist, etc;
  6. sometimes the association of several psychosomatic conditions in the same person
  7. same family history;
  8. increased incidence of symptoms during increased stress periods or after certain events (family quarrels, financial issues etc.);
  9. a mental traumatic event or long-term exposure to major stress, which in time has drained a person’s energy and reduced his/her coping abilities;
  10. in some cases, existence of an underlying mental disorder which is dominant in an individual’s mind (depression, anxiety, etc.)

Treatment of psychosomatic diseases

Therapeutic objectives:

  1. Reducing the level of anxiety, depression and in general of negative emotions (by pharmacotherapy and psychotherapy).
  2. Helping awareness and expression of feelings, enriching imagination, differentiation between sensations and emotions
  3. Improvement of mental health and autonomy
  4. Improvement of family, social group, professional group relationships, reducing negative emotions built up in time.
    Unexpressed negative emotions (e.g. stifled anger) are psychological factors that have a negative impact on the psychosomatic diseases (e.g. ischemic cardiomyopathy) and should be eliminated
  5. Better self-image, including body image.

Pharmacology treatment:

  1. Antidepressants
    Antidepressants in psychosomatic diseases are very useful, starting with their administration in ischemic cardiomyopathy in order to prevent occurrence of another heart attack and using them to treat the chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome.
  2. Anxiolytic medication
    Anxiolytic medication is useful in reducing anxiety in particular for acute psychosomatic diseases (ulcero-hemorrhagic rectocolitis, heart attack etc.), but also for a longer term, usually as an adjuvant for antidepressants and with a psychiatrically‑controlled prescription.
    Cognitive behavioral psychotherapy
    Cognitive behavioral psychotherapy is useful in psychosomatic conditions to:
  • reduce the impact of psychological factors on the patient’s condition;
  • change dysfunctional and maladaptive attitudes;
  • change behaviors with a negative impact on an individual’s health;
  • restructure incorrect cognition that triggers these behaviors.

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