Psychosomatic illnesses , or psychosomatic disorders (from other Greek. Ψυχή - “spirit”, “ soul ”, “consciousness” and σῶμα - body ) - a group of painful conditions that arise as a result of the interaction of mental and physiological factors. They are mental disorders manifesting at the physiological level , physiological disorders manifesting at the mental level, or physiological pathologies that develop under the influence of psychogenic factors. Sometimes synonyms of these conditions are used, such as “pathology of psychostasis” and “psychophysiological disorder” [1] . The term “psychosomatic” is not used in the International Classification of Diseases of the Tenth Revision (ICD-10) due to differences in its meaning in different languages and different psychiatric traditions, as well as in order not to imply the absence of significance of mental factors in the occurrence, course and outcome of others diseases [2] . Somatoform disorders ( F 45. in ICD-10 ) also by definition manifest themselves in the form of symptoms resembling a somatic disease , but differ from psychosomatic diseases by the obligatory presence of excessive anxiety for their physical health [3] .
Content
History
The problem of psychosomatic relationships is one of the most complex problems of modern medicine, despite the fact that the close relationship between the mental and somatic has been noticed and studied for many centuries, since the time of Hippocrates and Aristotle. However, the term "psychosomatics" was introduced by I. Heinroth only in 1818, and came into use from about 1934-1936. after the work of Denbar, Jeliff, Alexander, Wolf, and others, M. M. Kabanov emphasizes the need to overcome the artificial opposition of biological and psychosocial and defines psychosomatic diseases as “purely human” (1990).
At first, psychoanalytic concepts prevailed in psychosomatic medicine, according to which somatic health is determined by the state of the psyche (depressive affect can contribute to bodily illness in a person predisposed to this, and a sense of pleasure can have a rejuvenating effect on the body). There are a large number of theories that describe the causes and mechanisms of the emergence and development of psychosomatic diseases from the standpoint of various scientific schools.
Classification
Psychosomatic disorders can be divided into several large groups [4] . Symptoms are distinguished by pathogenesis, the meaning of the symptom and the functional structure of the psychosomatic connection, which is reflected in the psychosomatic disorder [5] .
Conversion Symptoms
A person unconsciously begins to show painful symptoms, which objectively are absent. This is often observed when a neurotic conflict receives a secondary somatic response in the form of a demonstration of symptoms as an attempt to resolve a social conflict. Conversion manifestations affect voluntary motility and sensory organs (for example, hysterical paralysis, paresthesias ("crawling creeps"), psychogenic blindness and deafness, psychogenic vomiting, pain phenomena).
Functional Syndromes
This is a functional violation of individual organs or systems. No pathophysiological changes in the organs are detected. The patient has a colorful picture of vague complaints that can affect the cardiovascular system, gastrointestinal tract, locomotor system, respiratory system and the genitourinary system (e.g. paresthesia, lumps in the throat, discomfort in the heart, neurocirculatory dystonia, functional disorders of the stomach , paroxysmal heart rhythm disturbances of various origins, etc.). All this is accompanied by internal anxiety, depressive symptoms, symptoms of fear , sleep disturbance, decreased concentration and mental fatigue.
Psychosomatosis
Psychosomatic diseases in a narrower sense. They are based on the primary bodily reaction to the conflict experience, accompanied by changes and pathological disorders in the organs. Appropriate predisposition may affect the choice of an affected organ or system. Historically, classical psychosomatic diseases (“holy seven” - “ bronchial asthma , ulcerative colitis , essential hypertension , neurodermatitis , rheumatoid arthritis , peptic ulcer and duodenal ulcer ” belong to this group [6] . Currently, these diseases also include coronary heart disease , psychosomatic thyrotoxicosis, type 2 diabetes mellitus , obesity and somatoform behavior disorders. However, based on the concept of changes in the functional asymmetry of the brain, accompanied by a violation of the functions of physiological systems that have temporary functional asymmetries, as the causes of psychosomatoses, it is proposed to add to psychosomatic diseases also radiculitis , migraine , intestinal colic , irritable bowel syndrome , gallbladder dyskinesia , chronic pancreatitis , vitiligo , psoriasis and infertility in the excluded pathology of the reproductive system.
Basic concepts of psychosomatic medicine
This section lists theories of the emergence and development of psychosomatic diseases [7]
Clinical-empirical approach
The clinical-empirical approach developed by U. Osler, R. Konechny, M. Boukhal considers psychosomatic relations both from the side of the psychosomatic process, a certain mental state or change of states that cause a registered physiological reaction of the body, and from the somatopsychic process - a certain state organism causing a mental reaction.
Classical Psychoanalysis
Classical psychoanalysis as a theoretical basis for psychosomatic representations ( Z. Freud , C. Jung , A. Adler). This concept opened for clinicians the protective mechanisms of the personality, methodical access to the unconscious through dreams, free associations, slips and disclaimers, as well as the theory of the collective unconscious , from which came the “theory of the symbolic language of organs” (S. Ferenczi).
Theory of Emotional Conflict
The theory of “specific emotional conflict”, founded by F. Alexander, showed the crucial importance of emotional stress states (emotional conflict situations and their physiological correlates) on organ function.
The concept of personality profiles
The concept of specific personality “profiles”, radicals, behavioral stereotypes (F. Dunbar), which tried to establish a correlation between somatic types of reactions and constant personality parameters in the form of certain personality radicals, patterns and behavioral stereotypes, which found its greatest expression in the popular concept of behavioral type “ A ” (D. Friedman).
Inability to emotional resonance
The theories of “ alexithymia ” (inability to emotional resonance) and “operational thinking” (specific thinking, freedom from dreams), according to which psychosomatic patients have a special pathognomonism of intrapsychic processing of intrapersonal conflicts and the specificity of verbal behavior (I. Ruzov).
The effects of stress
Experimental-psychological, clinical-physiological, biochemical and cytological studies of the effects of emotional stress (G. Selye, F.Z. Meerson and others), establishing the influence of extreme stressful situations on the susceptibility and characteristics of the pathogenesis, course and treatment of psychosomatic diseases. Moreover, in this direction there is a very large number of individual areas of study of psychosomatic pathology (stress and adaptive reactions, stress and stress injuries, stress factors and the picture of their subjective experience, etc.).
Psychophysiological direction
Psychophysiological direction (ASGevins, R. Jonson, F. B. Berezin , Yu. M. Gubachev, P. K. Anokhin, K. V. Sudakov, etc.), which is based on the desire to establish relationships between individual psychophysiological characteristics (for example , some neocortical-limbic characteristics or sympathetic-parasympathicotrophic manifestations) and the dynamics of visceral manifestations (activation of organ functions). The fundamental basis of the concept is the provision on functional systems.
Psychoendocrine and Psychoimmune Direction
Psychoendocrine and psychoimmune research areas (V. M. Uspensky, Ya. S. Zimmerman, V. A. Vinogradov, I. P. Myagkaya), which studies a wide range of neuroendocrine and neurohumoral phenomena in patients with psychosomatic diseases (psychoendocrine testing of the features and level of synthesis of catecholamines , pituitary and thyroid hormones, specific immunograms ). The search for “specific neurohormonal support” of emotional response showed that a high level of personal and situational anxiety is associated with multidirectional neurohormonal changes.
Neurophysiological Direction
Neurophysiological direction (I.T. Kurtsin, P.K. Anokhin, N.P. Bekhtereva, V.D. Topolyansky), which studies the neurophysiological support of persistent pathological conditions and explains the occurrence of psychosomatic disorders in disturbed corticovisceral relationships. The essence of this theory is that violations of cortical functions are considered as the cause of the development of visceral pathology. This takes into account that all internal organs have their own representation in the cerebral cortex. The influence of the cerebral cortex on the internal organs is carried out by the limbic-reticular, autonomic and endocrine systems.
Behavioral Medicine
In the framework of “behavioral medicine”, a pathogenesis model based on “visceral education” as well as behavioral education is proposed. This model of the pathogenesis of psychosomatic disorders is explained primarily by a person’s lifestyle and personality traits ( B. D. Karvasarsky ; Yu. M. Gubachev).
Functional asymmetry of the brain
The theory of violation of the "functional asymmetry of the brain" as the cause of psychosomatic pathology ( N. I. Kosenkov ). In process of social adaptation, an increase in the functional asymmetry of the brain occurs, which does not go beyond a certain boundary - the “critical zone”.
In the case of social maladaptation, the functional asymmetry of the brain reaches the “critical zone” and this leads to the emergence of psychosomatic pathology. The work of functionally asymmetric (having temporary asymmetries in secretory and motor activity) physiological systems of the body changes, which contributes to the release of the functional asymmetry of the brain from the “critical zone”. This leads to the emergence of a phase of remission of psychosomatic pathology, which may have a different duration of the course. There is a vicious cycle of psychosomatic illness, which can trigger both changes in the central nervous system and pathological disorders in the peripheral organs and systems involved in the disease process.
See also
- Psychosomatics
- Homeostatic theories of symptom formation in psychosomatics
Notes
- ↑ Stoimenov Y. A., Stoimenova M. Y., Koeva P. Y. and others. Psychiatric Encyclopedic Dictionary. - K .: “IAPM”, 2003. - S. 805. - 1200 p. - ISBN 966-608-306-X .
- ↑ World Health Organization . F4 Neurotic, stress-related, and somatoform disorders // International Classification of Diseases (10th revision). Class V: Mental and Behavioral Disorders (F00 — F99) (adapted for use in the Russian Federation). - Rostov-on-Don : "Phoenix", 1999. - S. 11. - ISBN 5-86727-005-8 .
- ↑ Chutko L.S. Somatoform disorders // MS. 2011. No. 1-2. URL: https://cyberleninka.ru/article/n/somatoformnye-rasstroystva (accessed March 30, 2019). Somatoform disorders (Rus.) // Medical Council: journal. - 2011. - No. 1-2 . - ISSN 2079-701X .
- ↑ “Psychosomatic patient at the doctor’s appointment” B. Luban-Plotze, V. Pöldinger, F. Kroeger. - M. , 1996 .-- 256 s.
- ↑ “Psychosomatic symptom as a cultural phenomenon” G. A. Arina in the collection “Psychosomatics: corporeality and culture: textbook for universities” / Ed. V.V. Nikolaeva. - M .: Academic project, 2009. - 311 p.
- ↑ Belousov Yu. V., Skumin V.A. Psychotherapy in pediatric gastroenterology. Study guide . - Moscow: Central Order of Lenin Institute for Advanced Medical Studies, 1987. - 115 p. - 1000 copies.
- ↑ "Reference psychologist"; Malkina-Pykh I.G .; EXMO; 2008; 992 pp .; 978-5-699-06449-4