Chapter 10: Theory of Psychosomatics

• Psychosomatics

  A specific place in the field of psychiatry for more than 85 years, studying the interaction between body and personality, soul and body, by emphasizing psychological factors that occur in different somatic conditions
• Many somatic diseases have an impact of stress on their etiology, as well as generalized anxiety
• Prolonged exposure to stress

  Can lead to physiological changes that eventually can cause somatic disease
• Stress

  • An evolutionarily determined psychosomatic reaction, which has an adaptive nature, an individual experience, and a cognitive appraisal of one event
  • Everyone gives a subjective meaning to the event and has coping strategies
• General adaptation syndrome (Selye, 1936)

  1. Alarm

  2. Resistance

  3. Exhaustion
• When a stressor is experienced by the individual as uncontrollable it leads to passivity, uncertainty, unknownness, perception of what is happening as more dangerous, and development of "learned helplessness"
• Neurotransmitter response to stress

  Activation of the noradrenergic system, leading to the release of catecholamines and serotonin, and increase in dopamine in the mesoprefrontal pathways
• Endocrine response to stress

  • Release of corticotropin-releasing factor from the hypothalamus, stimulation of the pituitary gland and production of adrenocorticotropic hormone, which leads to the release of cortisol from the adrenal cortex
  • Corticoids are associated with atrophy of the thymus gland and lymph nodes, as well as suppression of inflammatory reactions
  • Glucocorticoids are associated with providing energy to the body for a limited period due to increased glucose production
  • Secretion of thyroid hormones decreases
• Immune response to stress

  • Stress can suppress the immune system, with immune cells having receptors for adrenaline and endorphins
  • Humoral immune factors, called cytokines, interleukin 1 and 2, are released, leading to increased levels of glucocorticoids
  • In some individuals, serious organ damage is observed as a result of the oversecretion of cytokines
• Psychosomatic arc

  1. Current situation is perceived based on personality characteristics

  2. Information is processed by the thalamus, cortex, amygdala, hippocampus, and hypothalamus

  3. Biological and psychological responses are generated

  4. If the situation persists and available strategies do not help, dysregulation in neurotransmitters is reached, leading to fixed emotions and psychosomatic illness
• Our experience of illness can affect our ability to tolerate pain
• Attention to minor symptoms can heighten the sensation of pain, while anxiety and experience can also shape the perception of pain, usually intensifying it
• Psychosomatic symptoms

  • Can appear to be the result of somatic illnesses, but could be due to various psychological factors, as in the cases of conversion paralysis and somatization disorder
  • Conversely, some somatic diseases can manifest through various changes in behaviour and mental symptoms
• The relationship between biological and psychological factors in psychosomatic diseases is not fully understood, but mental processes are believed to be mediated through various neurotransmitter systems, which influence the endocrine and immune systems, causing the appearance of certain somatic symptoms
• Modern meta-analyses provide evidence that chronic anxiety can lead to ulcers in the digestive system, and stress contributes to the development of various somatic conditions
• There is still a lack of concretely established causality on this topic
• Recent developments in neuropsychiatry, along with advances in endocrinology and immunology, have provided more arguments which support various theories and hypotheses
• Mental processes are mediated through various neurotransmitter systems, which influence the endocrine and immune systems, causing the appearance of certain somatic symptoms
• Biological factors that disrupt the endocrine or other systems in the body are likely to affect different neurotransmitter systems, which would lead to the development of different mental manifestations
• The exact role of the immune system in this entire process remains poorly understood
• Plasma cells, lymphocytes, and immunoglobulins are likely to interact with both endocrine and neurotransmitter systems
• Chronic anxiety can lead to ulcers in the digestive system, and stress contributes to high blood pressure, which can have severe consequences for the heart, lungs, kidneys, and brain
• Patients with psychosomatics show a more pronounced tendency for hostility, anxiety, and depression
• Bronchial asthma has an allergic component in its etiopathogenesis, but stress can enhance this reaction
• Psychosomatic diseases

  • Mental disorders
  • CNS
  • GIT
  • Metabolic disorders
  • Oncological diseases
  • Respiratory system
  • Cardiovascular system
  • Autoimmune processes
  • Skin
  • Genitourinary system
  • Rare syndromes
• Mental disorders

  • Anxiety
  • Depression
  • Social avoidance
  • Somatization
  • Hypochondria
  • Conversion
  • Pain
• Mental disorders

  • With each of these mental disorders, different personal and social causes can be found in its etiology: a way of perceiving oneself, others, and the world, experiencing psychological trauma, micro and macro traumas
• Tension headache

  Consequence of prolonged spasms of the neck muscles spasms of the arteries and reduced blood flow to the brain, which is associated with a state of anxiety and stress
• Migraine headache

  Can be triggered by eating foods rich in tyramine and exercising
• GIT diseases

  • Very often the debut of these diseases begins after various stressful events. Typical for these patients is expressed passivity as a personality trait, obsessive traits, and childhood psychological traumas. Fear of punishment, repressed and masked hostility behind polite behaviour. Suppressed aggressive impulse due to the presence of sanctioning Superego. Often the debut is at the age of puberty and with frequent family conflicts
• Gastric ulcers

  Increased acidity of gastric juice and pepsin is observed, which is associated with mucosal damage. It occurs in people who abuse coffee, and alcohol, sensitive to stress, and are prone to anxiety and addiction: strongly frustrated needs, anger, and shallow self-esteem. Disappointment and dissatisfaction are very common - the presence of unconscious conflicts
• Obesity

  Hyperphagia reduces anxiety and the presence of emotional hunger, which is satiated by food intake. Night-eating syndrome is associated with insomnia - the presence of dependent behaviour and verbal conflict
• Diabetes

  Often triggered by mental stress. From a psychological point of view, it is considered a disease of adaptation. More common in anxious and depression-prone patients. Persons suffering from diabetes mellitus tend to react to stressful situations with hyperbolized physiological reactions, which are often observed during fasting. In type 1 diabetes mellitus, the inheritance of the disease is also very important. Stress is associated with an epigenetic etiopathogenetic factor
• Oncological diseases

  • They are often preceded by experiencing stressful events. More common in people who have great difficulty exteriorizing their emotions in their authentic spectrum. In many of the patients, latent resentment is detected. Patients with mental disorders more often suffer from oncological diseases
• Asthma

  Stress can precipitate an asthma attack, respiratory infections, or allergies. Overprotective parents may be a risk factor for bronchial asthma. The presence of pronounced dependence and separation anxiety disturbed parental relationships, and frequent conflicts in the family. Loss of a parent due to death or divorce. It is more common in children with anxious and insecure mothers. Presence of unrealistic, inadequate subjective self-image, family, and family climate. Family conflicts are a reason for children to be exposed to the disease, with a secondary benefit - uniting the family around the sick child and not around the conflict. It is very common to see a mix of the role model in the family and the involvement of the child in the parental dynamic. Infantilism and an underdeveloped value system are noticeable in the personality traits, that determine destructive behaviour, a consequence of psycho-traumatic factors
• Hyperventilation syndrome

  It is often found in panic attacks, and generalized anxiety disorder, accompanied by tachycardia and vasospasm
• Cardiovascular system disorders

  • Type A personality, aggressiveness, irritability, low frustration threshold - prone to coronary pathology. Arrhythmia is common in anxiety states. Sudden cardiac death in ventricular arrhythmia conditions occurs in people who experience massive psychological shock. Risky lifestyle: smoking, alcohol abuse, sudden weight loss, overweight, high or very low cholesterol levels
• Arterial hypertension

  Severe stress leads to increased production of norepinephrine, which increases systolic blood pressure. It is more common in people who tend to suppress anger and feel guilt associated with aggressive impulses. Presence of a need for recognition by authorities. Chronically frustrated people, with a pronounced need for tenderness and love, are more often sick. An unconscious need for dependency left over from childhood, which with age unlocks a sense of wounded dignity and inadequacy. A need for self-reliance, independence, and self-assertion, is transformed by oral frustration into oral aggression, which remains repressed because it is not acceptable to the Superego
• Syncope, hypotension

  The vasovagal reflex accompanied by anxiety or fear can result in a sharp drop in blood pressure, pallor, and fainting. Occurs in patients with hyperactive autonomic nervous system
• Severe stress can be a trigger for autoimmune diseases, such as rheumatoid arthritis, systemic lupus, etc. Chronic stress, anger, or depression can worsen their course