Psychosomatic

disorders.
It's far more important to know what
person the disease has than what
disease the person has.

Hippocrates
 General definitions:

 Psychosomatics – is the brunch of

medical psychology studying psychical
factors in the development of functional
and organic somatic diseases.
 Psychosomatic
interrelations
 Psychological factors as a cause of somatic
disease (proper psychosomatic diseases).
 Mental disorders which manifest with
somatic symptoms and signs (somatization
disorders).
 Mental consequences of somatic diseases
(including psychic reactions to the fact of
somatic disease).
 Incidentally simultaneous mental disorders
and somatic diseases.
 Somatic complications of mental disorders.
 Psychoanalytic explanation of
psychosomatic pathology
- emphasizing the prevail of
forcing out emotional
experience (protective mental
mechanism which manifests
with subconscious exclusion of
the undesirable thought or
emotion from the conscience)
which later manifest with
somatic symptoms and signs in
the patients with psychosomatic
signs.
 Cortic-visceral theory of
psychosomatic pathology

Psychosomatic disorders
are based on a “collision”
of conditioned reflexes,
which contains logically
insoluble contradictions
 Psychosomatic diseases
«holy seven»
 Essential hypertension
 Stomach ulcer
 Bronchial asthma
 Neurodermitis
 Thyrotoxicosis
 Ulcerative colitis
 Rheumatoid arthritis
 Features of psychosomatic
disorders
Psychic stress plays a key role in the
origin.
The disease becomes chronic or relapsing

after manifestation.
The first manifestations can be noted at
any age, but chiefly in teen-agers.
 Forms of mental protection
 Forcing out. This is inhibition or exclusion
of unpleasant or unacceptable events or
phenomena which cause anxiety.
 Substitution is switching from an
unpleasant, causing anxiety experience
(subject) to another people.
 Rationalization. This is an attempt to
substantiate the desires and acts if
recognition of their course could threaten
with loss of self-respect.
 Projection is unconscious transfer of
unacceptable feelings to another person,
ascribing somebody’s own socially
inappropriate desires, motives, acts and
qualities to the surrounding persons.
Forms of mental protection (cont.)
 Somatization is exit from a difficult
situation with fixation on the state of health
(must be significant benefit of illness).
 Reactive formation. In this case
unacceptable tendencies are changed to the
opposite ones. Thus, turned down love is
often expressed in hatred to the former
object of love, boys try to hurt the girls they
love etc.
 Sublimation is transformation of
unacceptable impulses to socially acceptable
forms of instinctive requirements which
cannot be realized in an acceptable way.
 Forms of mental
protection (cont.)
 Regression. This is turning back to primitive
forms of reaction and behavior, especially in
children.
 Negation. This is a protective mechanism,
which does not recognize but rejects
impracticable desires, intentions, facts and
actions by unconscious negation of their
existence, that is real phenomena are
believed to be not existing. It is necessary to
emphasize that negation is not a conscious
attempt to renounce, like in mimicking or lie.
 Psychoemotional factors of
physiological disturbances:

In the cardiovascular
system – increased
heartbeat, changes in
the blood pressure,
vascular spasms;
 Psychoemotional factors of
physiological disturbances:

In the
respiratory
system –
delay,
increased or
decreased
respiratory
rate;
 Psychoemotional factors of
physiological disturbances:
In the
digestive
system –
vomiting,
diarrhea,
constipation,
increased
salivation,
dryness in the
mouth;
 Psychoemotional factors of
physiological disturbances:

In the sexual
sphere –
increased
erection, weak
erection, clitoris
swelling,
lubrication of
the sex organs,
anorgasmia;
 Psychoemotional factors of
physiological disturbances:

In the muscles –
involuntary
reactions:
muscular strain,
tremor;
 Psychoemotional factors of
physiological disturbances:

In the
autonomic
system –
perspiration,
hyperemia.
 Characteristics of the true
psychosomatic disorders:
 A key role of a psychic stress.

 Chronic/ relapsing type of cours.

 Teen-agers.
 Reasons of
psychosomatic disorders
 Chronic stress and emotional tension
 Quarrels with close relatives,
 conflicts with others
 reprimand from the authorities
 traffic jams when you’re in a hurry
 chronic lack of time
 information overload
A chain is only as strong as its weakest
link.
 Reasons of
psychosomatic disorders
(cont.)
 Long experience of strong negative
emotions
 Increased blood pressure
 changes in muscle tone in different parts of
the body
 changing the type of breathing
 etc.
Reasons of psychosomatic
disorders (cont.)
 Unreacted emotions
 «A sadness that does not manifest itself in
tears makes other organs cry» Acad.
K.M.Bykov
 Unexpressed, repressed emotions go
"inside" (somatization).
 Aggression comes to self-aggression
 Alexithymia
 Personality trait, inability to identify and
describe emotions in the self
 10% of population
 difficulty identifying feelings and
distinguishing between feelings and the
bodily sensations of emotional arousal
 difficulty describing feelings to other people
 constricted imaginal processes, as evidenced
by a scarcity of fantasies
 a stimulus-bound, externally oriented
cognitive style.
Reasons of psychosomatic
disorders (cont.)
 Motivation or conditional benefit
 people use their own disease as a way to
solve their psychological problems.
 they don’t understand the connection
between the disease and his psychological
problem
 Essential hypertension:
 Intrapersonal conflict;
 Interpersonal strain between aggressive impulses
and feeling of dependence on the other hand;
 The wish to manifest hostility at a simultaneous
need of passive and adaptive behavior;
 The contradictory personal rushes conflicts;
 Suppression of negative emotions.
 Coronary artery disease:
“Coronary personality”:
 Hostility,
 Excessive aspiration to competition,
ambition,
 Constant feeling of lack of time
 Concentration on limitations and
prohibitions.
 Asthma:

 The relations of not satisfactory

subordination;
 contradiction between “desire of
tenderness” and “ fear of tenderness”;
 hysteric or hypochondriacal fitures;
 hypersensitive.
 Gastritis and Ulcer:

 Conflicts between guardianship and

independence;
 Need of protection, support and guardianship;
 Explosive emotions;
 Categorical thinking;
 Inappropriate for self-perception;
 Negative emotions.
 Colitis:
 Experiencing “loss of the object”
 “Catastrophe of experience”;
 Decreased self-estimation;
 Excessive sensitivity;
 Strong desire of protection.
 Colitis:

Equivalent of grief
 Prophylaxis of
psychosomatic diseases:
 Treatment by general physicians
(psychic self-regulation, autogenic
training).
 Psychotherapy (personality-oriented
psychotherapy).
Psychological reaction on illness
 Depression
 Anxiety
 Grief
 Hypochondria
 Fear of death
 Asthenia
 Confusion
 Psychogenic reactions
 Cardiovascular system – tachycardia,
hypertension
 Respiratory system – tachypnea,
bradypnoea
 Digestive tract – constipation,
diarrhea, salivation, dry mouth
 Muscles – spasms, tic
 Autonomic (vegetative) nervous
system - hyperhidrosis (sweating),
hyperaemia
 Factors of disease
 Gender – pain sensitivity
 Subjective importance of various
organs
 Age:
 Children – general appearance
 Adults – chronic disease, invalidity,
social and financial importance of
disease; “Shameful” diseases
 Old age – threat of death
 Profession
 Factors of disease
 Temperament
 Personality – philosophy, religion,
culture
 General education
 Medical education
The most important factors of disease
 Possibility of fatal outcome
 Possibility of invalidity and chronic course
 Pain
 Radical or palliative treatment
 Therapeutic or surgical treatment
 Ability to keep previous level of
communcation
 Social importance of disease in society or
in the reference group
 Influence on sexual activity
 Influence on sphere of entertainment,
recreation
Oncological diseases (stages)
 Anosognosia, waiting of "verdict"
 Dysphoria, protest, suicidal

attempts,
anxiety, realization of late diagnosis
 Autosuggestion – acceptance,

“haggle” for no pain, religion,

reappraisal of values
 Depressive stage

 Apathy – conciliation
Psychological factors of tumor
 A patient attitude is more important
than localization of a tumor
 Female: fear to lose reproductive
performance; breast cancer.
 Gynecology
 First menstruation (menarche) - fear
and neurotic reactions, pain
 Premenstrual syndrome
 Climacterical period (menopause)
 Artificial (postoperative) menopause
 Features of gynecological
examination – pain, shyness
 Pregnancy and delivery
Fears:
 Phisiological aspects of pregnancy
 For a fetus
 Care for a baby
 Delivery
 Feeding
 Psychoprophylaxis of delivery
 Therapy
 Chronic pain
 Change of sphere of activity
 Cardiovascular diseases – attitude to
illness, doctor recommendation
 Infectional diseases – shame,
shyness, asthenia
 Surgery
 “Magic” of surgeon, hope of fast
recovery
 Fear of operation, loss of organ
 Loss of an organ
 Feeling of inferiority
 Overestimation of equipment,
underestimation of a patent’s mental
state
 Psychological factors in plastic
surgery
 Pediatrics

 Interrelation mother-child-doctor
 Reaction on hospitalization
 Parents’ reaction on disease
 Gerontology
 Comorbidity
 Involutional changes
 Atypical manifestation
 Social desadaptation
 Euthanasia
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