Psychosomatic Disorders

Physical illnesses that are believed to be psychologically based; also referred to as psychophysiological disorders.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSMIV) classifies psychosomatic illnesses under "Psychological Factors Affecting Physical Conditions." Physicians have been aware that people's mental and emotional states influence their physical well-being since the time of Hippocrates. In the twentieth century, the discoveries of psychologists have shed new light on how the mind and body interact to produce health or illness. Sigmund Freud introduced the idea that unconscious thoughts can be converted into physical symptoms (conversion reaction). The formal study of psychosomatic illnesses began in Europe in the 1920s, and by 1939, the journal Psychosomatic Medicine had been founded in the United States. Eventually, sophisticated laboratory experiments replaced clinical observation as the primary method of studying psychosomatic illness. Researchers in the field of psychophysiology measured such responses as blood pressure, heart rate, and skin temperature to determine the physiological effects of human behavior. Animal research have also contributed to the growing body of knowledge about psychosomatic disorders. Three theories have been particularly popular in explaining why certain persons develop psychosomatic disorders and what determines the forms these illnesses take. One theory contends that psychological stress affects bodily organs that are constitutionally weak or weakened by stress. Another links specific types of illness with particular types of stress. Still another theory suggests that physiological predispositions combined with psychological stress to produce psychosomatic illness.

The parts of the body most commonly affected by psychosomatic disorders are the gastrointestinal and respiratory systems. Gastrointestinal disorders include gastric and duodenal ulcers, ulcerative colitis, and irritable bowel syndrome. (Anorexia nervosa and bulimia are sometimes considered psychosomatic disorders, but they also appear under the category of "anxiety disorder—eating disorders" in DSM-IV.) Respiratory problems caused or worsened by psychological factors include asthma and hyperventilation syndrome. Cardiovascular complaints include coronary artery disease, hypertension, tachycardia (speeded-up and irregular heart rhythm), and migraine headaches. Psychosomatic disorders also affect the skin (eczema, allergies, and neurodermatitis) and genitourinary system (menstrual disorders and sexual dysfunction).

Probably the most well-known psychosomatic connection is that of stress and coronary heart disease. The term "Type A" has been used for over twenty years to describe the aggressive, competitive, impatient, controlling type of person whom researchers have found to be more prone to heart disease than people who are more easygoing and mild-mannered and less hostile and concerned with time. In 1981, a panel appointed by the National Heart, Lung, and Blood Institute found that Type A behavior poses a greater risk of coronary heart disease and myocardial infarction (heart attack) than do cigarette smoking, age, hypertension, or a high serum cholesterol count.

Emotional stress can also affect the immune system, raising the risk to the body from such foreign invaders as bacteria, viruses, and cancer cells. People under stress are more likely to develop infectious diseases, including those stemming from the reactivation of latent herpes viruses. It is known that several of the body's reactions to stress, including the release of cortisol, adrenaline, and other hormones, suppress the activity of the immune system. A special field, psychoneuroimmunology, studies how the interaction of psychological and physiological reactions affects the functioning of the immune system.

People suffering from psychosomatic disorders have been helped by treatment of either their physical symptoms, the underlying psychological causes, or both. If the disorder is in an advanced stage (such as in severe asthma attacks, perforated ulcers, or debilitating colitis) symptomatic treatment must be undertaken initially as an emergency measure before the emotional component can be addressed. Psychological approaches range from classic psychoanalysis, which addresses a person's early traumas and conflicts, to behavior therapy that focuses on changing learned behaviors that create or increase anxiety. Medications such as tranquilizers or antidepressants may be effective in relieving symptoms of psychosomatic disorders. Hypnosis has successfully been used to treat hyperventilation, ulcers, migraine headaches, and other complaints. Today, psychologists commonly treat psychosomatic ailments with the aid of such relaxation techniques as progressive relaxation, autogenic training, transcendental meditation, and yoga. Biofeedback has been used in treating a number of different clinical problems, including tachycardia, hypertension, and both tension and migraine headaches.