Ist MD Materia Medica,
disorders are once called as
Refer to a group of disorder
in which conditions are
disturbed due to emotional
stress due to psychological
It is an illness whose symptoms are caused by
mental process of the sufferer rather than
immediate physiological cause. If a medical
examination can find no physical or organic
cause, or if an illness appears to result from
emotional conditions such as anger anxiety,
depression or guilt, then it might be classified as
psychosomatic.However in some illnesses
psychological factors seems to play a particularly
important part.They can influence not only the
cause of the illness but can also worsen the
symptom and can affect the course of the disorder.
Psychological factors are important in every
-irritable bowel syndrome
-high blood pressure
sometimes psychological factors can cause
illhealth,without actually causing disease.
Eg;anxiety,stress due to personal
problems leads to physical illness.eg;stress
Psychosomatic symptoms show that a
human being can create physical symptoms
that compensate for relation ship
deficiencies. (E.g. Hypnosis induced allergic
reaction, indicates that a persons immune
response can dramatically change during
an intense mind body relationship.
Mind can cause physical symptoms for example, when
we are afraid or anxious we may develop a fast heart
rate, palpitations, feeling sick, shaking (tremor) sweating
dry mouth, chest pain, headache, a knot in the stomach
and fast breathing.
The physical symptoms are due to an overdrive of the
nervous impulse sent from the brain and to various parts
of the body and to release of adrenaline into the blood
stream when we are anxious.
There is also some evidence that the brain may be able
to affect certain cells of the immune system, which is
involved in certain physical diseases.
HISTORY OF THE CONCEPT
The term ‗psychosomatic ‗ is proposed as early as
1818.in 1935 dunbar published a book on ‗emotions and
The high incidence of psychosomatic
disorders among military personnel exposed to wartime
stresses during 2nd world war also contributes to the
concept of psychosomatic diseases.
Examples of modern researches are
-animal experiment of Pavlov on the
conditioned salivary reflex(1928)
-cannon-1932-physiological effect of
intense emotional stimuli. He demonstrated that
stimulation of autonomic nervous system particularly
sympathetic nervous system.
-1950-harold wolff observed
physiology of gastro intestinal tract appear to
correlate with the emotional state.hyper function
associated with hostility.and hypofunction
associated with sadness.
The history of psychosomatic medicine dates to
ancient beliefs that the body can be affected by
HOW DOES A PSYCHOSOMATIC
DISORDER OCCUR ?
Illness can be due to many factors.It can occur as a result of
social or environmental factors,genetic or hereditary factors etc. A
tendency for certain condition also run in
families. Some families also tend to suppress feelings.any
emotion tends to be expressed by physical symptoms.children
may learn this behavior which may continue to adult life.Some
people think that it is our personality that is a major factor in
determining which illness they develop. For example people with
what is known as type A personality tend to be ambitious,
impatient, and set themselves high standards.they seem more
likely to develop heart attacks.quet introverted individuals,who
tends to conceal their feelings and fears and to suppress
emotions, may be more likely to develop cancers.
WHY DOES A
Why the illness occurs at a particular time is
often a mystery.it could be that a
combination of the factors mentioned above
triggers off the illness.Should there be
untoward stress due to personal problems
at home or at work, or bereavement, then
an illness may result. We know for instance
that certain life events such as moving
house, getting divorced or suffering a
bereavement can precipitate physical
illnesses.Similarly, an existing illness may
worsen as a result of these stresses.
• The commonly recognized psychosomatic
conditions are clasifie according to the
organ system involved are:-
• Gastro intestinal--peptic ulcer, ulcerative
colitis, anorexia nervosa, irritable bowel
• Cardiovascular—essential hypertension,
angina pectoris, myocardial infarction,
cardiac neurosis, paroxysmal tachycardia
• Respiratory – bronchial asthma,
vasomotor rhinitis, and hay fever.
Urogenital – impotence, frigidity, menstrual
disorders, like ammenorrhoea, dysmenorrheal,
menorrhgia, metropathica haemorraghica, pre
Endocrine—hyperthyroidism (graves disease),
diabetes mellitus, obesity.
Skin –uriticaria, psoriasis, hyper hidrosis,
Musculoskeletal—rheumatoid arthritis, tension
• Increased acid secretion
• Inhibited dependence, general stress
Conflict over hostility, general
• Bronchial asthma
• Conflict over wish for protection
• or separation,
• anxiety, general stress
Conflict over control & general
• Increased TSH secretion
• Conflict over premature self
Conflict over an obligation
The revised fourth edition of ―Diagnostic and Statistical
Manual of Mental Disorders‖ (Dsm- Iv –TR) does not use
the term psychosomatic instead it describes the
psychological factors affecting the medical conditions as
―one or more psychological or behavioral problems that
adversely And significantly affect the course or outcome
of a general medical condition, or that significantly
increase a persons risk of an adverse outcome‖
Criteria in the tenth revision of
the ‗international classification of disease and related
health problems‖ ( ICD-10 ) are more general than the
According to the classification of ICD-10, the
psychosomatic disorders are described in chapter F-45.
According to the classification they can be divided into:-
I. SOMATIZATION DISORDERS-
1) Multiple somatic symptoms in the absence of any
2) The symptoms are recurrent and chronic
3) Symptoms are vague and narrated in dramatic
manner and involve multiple organs
4) Frequent change of treating doctor
5) presence of conversion symptom is common- it
should be differentiated from other physical complaints
like multiple sclerosis ,hypothyroidism ,hyper
thyroidism,SLE, pancreatic cancer and also from
psychiatric disorders like schizophrenia ,hypochondrias
is, conversion disorder ,delusion disorder etc.
persistent preoccupation with a fear or belief of
having one or more serious diseases based on
persons on interpretation of a normal body
function or a mionor physical abnormality. On
examination no physical abnormality found. Pre
occupation with medical terms is common.
Change of physician is also is common. Course is
usually chronic with remissions and relapses.
Ahge usually late third decade.
III. SOMATOFORM AUTONOMIC
The symptoms are narrated as if they
were due to physical disorder of an organ system
that pre- dominantly under autonomic control.
For example – heart and CVS palpitation, upper
GIT ( aerophagy , hiccough ), lower GIT (
flatulence, IBS, ) respiratory system (
hyperventilation ), genitourinary system (
dysuria), other organ and systems.
IV.PERSISTENT SOMATOFORM PAIN DISORDER:-
TREATMENT INVOLVED FOR A
Persistent, sivere and distressing pain is the
main feature which is either grossly in excess or inconsistent with
anatomical distribution of the nervous system. Pre occupation with
pain is common. More common with females and the onset is in
the third and fourth decades. The pain is not produced intension
ally and is not under the patients‘ control. Pain is of two types:-
Pain disorder associated with psychological factors and non
identifiable medical condition.
Psychological factors play a major role in the onset, severity,
exacerbation or maintenance of the pain.
Pain disorder associated with psychological factors and also
general medical condition. Both these factors have important role
in the onset, severity, exacerbation or maintenance of pain.
1.psychosomatic disorder causes damage in
physical level,somatoform disorder does not.
2.psychophysiological disorder invole
internal organs ie;lungs,viscera,heart
etc.somatoform disorder invole bodily
3.patients suffering from
psychophysiological disorders are anxious
about their symptoms and feelings.
-individual suffering from somatoform
disorder are attention seeking,but not
anxious about their symptoms.they show no
Experimental and clinical evidence
has shown that the emotional
disturbances could be responsible
as predisposing, precipitating and
perpetuating factors in this illness.
Several etiological theories have
the autonomic nervous system influences and is influenced by
both, other parts of the nervous system and the endocrine glands.
Complex inter relation of these various structures have been
postulated to explain the translation of the conflicts arising from
the problems of the every day living into abnormal physiological
functions and tissue damage. The hypothalamus being the centre
for the sympathetic and parasympathetic nervous activities is of
central importance In these feed back circuits.
It is postulated that emotional disturbances acting through the
hypothalamus affect the sympathetic and parasympathetic
nervous system, which results in alteration in the structure of the
viscera to which these systems innervate.
The imbalance of the sympathetic and the parasympathetic
nervous activities would alter the function of the viscera.
The end result of all these change reactions would be the
revitalization of the organs. Eventually the organ becomes more
susceptible to external and internal stimuli.
2.ORGAN SYSTEM WEAKNESS;
weakness of a specific organ system is largely as
a result of genetic influence or prior damage of a
given system.eg; a person may be othervise
healthy may have a poor respiratory system.such
individuals are more likely to develop bronchial
According to this theory the basic underlying defect is the
weakness of the ego, which help an individual to face the realities
The development of both the ego and the
personality of the person takes shape mainly during the first few
years of life.teh future pattern of behavior are laid down during the
That individual who suffers from psychosomatic
disorders certain infantile residues persists in later years.
Whenever such individual faced with stress of later life which they
cannot cope with adequately, these stress leads to psychological
or physiological regression to these infantile or immature patterns
of functioning resulting in the development of psychosomatic
This point is explained in the work of Alexander and dunbar.
According to this concept- psychophysiological
disorders are symbols of unsolved unconscious conflicts and
Eg; unsolved dependency leads to the development of fear
Lechman pointed out that psychosomatic disorder is a learned
disorder.5 methods of learning process which leads to specific
1.THE ROLE OF STIMULUS SUBSTITUTION THEORY- if a person
respond to neutral stimuli associated with one action producing
stimuli, soon the patient learns to respond to neutral stimuli.
Eg; while it is raining,a child is frightened not by raining but
by lightning and thunder outside.however on subsequent occasion
even slight raining may lead to fear reaction in the absence of
thunder and lightning.
2.THE ROLE OF EMOTIONAL REINTEGRATION
A single component in the stimulus situation which is earlier
associated with a complex pattern of emotional reaction may itself be
effective in producing the total complex pattern of emotional
reactions.eg; a boy fell into a river while fishing and was completely
drowned.from this single stimuluspeople fishing or sight of that bridge
serves to revive emotional reactions associated with earlier event.
3.THE ROLE OF STIMULUS GENERALISATION
eg;swimming in water may evole emotional
reaction that the boy felt after falling in the icy water.
4.ROLE OF SYMBOLIC STIMULI;stimuli in the personal
history of the individual represent effective emotion
Eg;the word ‘rape’ may provoke strong
emotional reactions in a woman who has been sexually
5.THE ROLE OF IDEATION
organismic affections of stimuli in terms of cns
manifestation, may persists in the form of thoughts or
ideas.eg;an individual may think about an emotional
event may feel associated emotion.(criticized by an
employer may feel anxiety)
5.DIATHESIS STRESS THEORY
• IT means psychological or physiological
predisposition.diathesis when associated
with stress is likely to develop a
psychophysiological disorder in an
TREATMENT INVOLVED FOR A
Increasingly doctors are recognizing the importance of dealing
with psychological and social factors in relation to physical disease.As
a result,many doctors now try to deal with the whole person. This
means taking all these factors into consideration. By doing this, it is
important to realize that the doctor is not playing down or ignoring the
physical disease.Many people with so called psychosomatic disorders
feel that their doctor does not take them seriously.They feel that the
doctor believes that it‘s all in the mind.The doctor will always attempt to
treat the physical illness with appropriate medical treatment if
necessary.But he will also be interested to understand more about the
person who has the illness.This will inturn help him and the person to
understand the illnessbetter.Sometimes it is helpful to look at the whole
lifestyleof the person involved.This may require lokking at how the
stress is involved.This may require looking at how the stress is dealing
with,teaching techniquesfor stress management, as well as examining
factors such as diet and exercise.
1.PSYCHODYNAMIC APPROACH IN THE
• suggested by KARASU-says that effectiveness
of this therapy depends on the patints
preparation for the therapy.
• First step _ health alliance where the therapists
builds trust in the patient by being supportive.
• 2nd step –therapist become more reliable and
trust worthy.at this stage actual therapy may
begin.this process is time consuming.ie;6-7
• KELLNER –says that this approach is effective
in diseases like peptic ulcer,asthma and
migraine and not inhypertension and ulcerative
• Success of treatment depends on
individual rather than disease.ie if the
person has high hypnotic ability hypnosis
can be effective.hypnosis directly influence
autonomic nervous system functioning.
• Traditional psychotherapy
approach;especially in ulcerative
colitis(they are overly dependent and
symbiotic in nature)
II. BEHAVIORAL APPROACHES
• -to modify the environmental
• -reinforcement like special
attention or over protection is totally
• -reinforced with rewards.
• Certain instruments which will inform the
patient about the psychophysiological
processes and then he is taught to bring
them under voluntary control.
• Biofeedback technique-individual can
control blood pressure,skin
temperature,muscle tension etc.
• -HOMOEOPATHIC-according to Hahnemann
§225,corporeal diseases originating from emotional
causes such as continued anxiety,worry
vexation,wrongs and frequent occurrence of great
fear and fright.these are called psychosomatic
• Treatment is mentioned in§ 226 that by meas
of psychical remedies such as display of
confidence,friendly exhortations,sensible advices
and often by a well disguised deception be rapidly
changed into a healthy state of mind.
• But the fundamental cause in these cases is
also a psoric miasm.so the seemingly cured patient
should be subjected to a radical antipsoric treatment
• iv.SPECIFIC DISEASES
• ASTHMA;-if emotional factors-
psychotherapy or hypnosis is used.
• MIGRAINE;-biological and psychological
approaches are used in the treatment.
• AFTER TREATMENT FOR A
• The reasons that the illness arose are often
complex and not easy to deal with.They can be
confusing for the doctor as well as the
patient.Time is required to allow the
understanding if healing is to take place.There is
no quick and easy answer.During the course of
treatment the patient may feel that he is not
being understood. It is important to share these
feelings with the therapist or doctor.
• EFFECTS ON FAMILY OF A
• People with psychosomatic disorders need
the support and understanding of the
family and friends. Nospecial expertise is
required. A person who will listen and
provide support at times of crisis is all that
CAUSES OF DEVELOPMENTS OF
One of the most common psychosomatic disorder found among
the executives and those staying in urban areas.characterised
by the presence of crater like holes in the lining of the stomach
or duodenum due to excess of acid and pepsin in gastric juice.
CAUSES OF ULCER;there is biological predisposition towards
high level of pepsinogen secretion,which is genetically
aquired.ie;people with hypersecreting stomach&people with
marked individual difference in pepsinogen level even at birth.
Those who develop ulcer usually have stressful life evevents-
leads to the development ulcer.eg;separation from loved ones
Psychological and intrapsychic factors are important in the
development of ulcers.Franz Alexander suggested that-unmet
dependency needs anger oriented reaction,persistent conflict &
repressed hostility leads to developments of ulcer.
• 2.TENSION HEADACHE AND MIGRANE HEADACHE;
• 90% of headaches have emotional cause.tension
headache is a disorder of musculoskeletal system and
migraine is a disorder of cardiovascular system.
• MIGRANE;Inherited genetic predisposition causes
changes in the vascular system-causes dialatation of
extracranial arteries.when individuals are unable to cope
with the personal function& conflict they develop
increased intracranial pressure leading to
vasoconstriction and migraine.
• 3.ESSENTIAL HYPERTENSION
• Physiological predisposition is the chief cause.individuals
with hyperactive sympathetic nervous system increases
blood pressure.also there is some predisposition to
certain personality traits;ie inhibited hostile tendencies or
chronic feeling of hostility leads to hypertension.
4.CORONARY HEART DISEASE;
Certain individuals are more prone to CHD due to
situational challenges they face.they are called
typeA individuals.(concept by Friedman and
Rosenmann)they are emotional achievement
conscious,perfectionistsand are always functioning
above their physiological baseline are predisposed
to coronary heart disease.
According to Lipowski-combination of biological
andpsychosocial factors are responsible for the
development of CHD.