Psychosomatic disorders

Multilevel ethology

Peptic ulcer - access production of the acid causes the ulcer in the stomach. Psychosomatic disease - due to stress and social conflict between people. Usually treated by tranquilizers to calm down the psychological stress - sent to places to rest

Desomatisation

The internal signals are suppressed and dont feel anything more from the internal organs. However, psychoanalysis says, if these get de-suppressed then we will feel the internal functions = resomatisation

Regression

Every psychoanalytiv theory agree that one of the basic mechanism behind psychoanalysis is regression, goes backwards

The psychosomatic disease

Theoretically,alldiseasesarepsychosomatic,since the emotional factors influence every somatic processes via the neural and hormonal ways. (Alexander )

Basic fault (Balint) - psychoanalytic model

Balint came up with the idea that hte basic idea behind psychosomatic diseases = basic fault, which is the conflict between mother and child which changes the behavior of the infant. Psychological functions, like an imprinting

Individual response pattern specificity - dynamic psychopathological approaches

Forming from the early childhood (specific relationship is formed among some organ systems and dynamic psychological avoidance mechanisms or among certain emotional states and organ functions • evolves during the early development • strong emotional conflict enhanced reactivity of one or more organ(system)s • insolvable emotional conflict in child- or adulthood • emotional regression • influence of the social-interpersonal environment

Psychosomatics

"Psychosomaticsisaglobalapproach towards the integration and the entirety of relationships of several - somatic, psychological, social and cultural - systems.

Conflict specificity (Wolman) - psychoanalytic model

- Asthma - fear of a child of loosing the mother - Hypertension - difficulties to control one's own aggression - Arthritis (females) - protest against parental power and movement restrictions - Gastric ulcer - inner conflict between dependency and independence desire - Skin disorders - conflicts because of too much closeness - Thyreotoxicosis - fear of the death - Colitis ulcerosa - hostility.

Psychoanalytic models

- Freud refused psychosomatic in the first place. Later he changed his mind and accepted this approach. - Dunbar is one of the psychologists who dealt with psychoanalysis and psychosomatics in a psychoanalytic way. As cellular pathology had awaited for the discovery of the microscope, dynamic psychology has awaited something that could be called its microscope, the psychoanalytic method - Dunbar. - Included a lof of factors which are important in psychosomatic diseases. - By 1937 there were 4714, and by 1953 an additional 412 cited publications in the field of psychosomatics

Researchers approach to psychosomatics

- Prove the role of psychological and social factors in the ethiology - Generally focus on the patient - The process leading to disease is more interesting - Closer to psychoanalysis - They are diagnosis-oriented

Clinicians approach to psychosomatics

- The way by which psychological factors lead to disease is not important - Generally focus on the disease - Chronic states are also interesting - Closer to behaviorism - They are therapy-oriented

Circulatory system diseases

- arithmias - essential hypertension - hypotonic collapse; - angina pectoris and myocardial infarction (heart disease); - panic-syndrome

Elements of the psychogenesis

- characteristics of infant care - occasional emotional traumas - later emotional experiences, - emotional climate and relationships of the family

Cortico-visceral (Pavlov) - psychophysiological model

- emotions are accompanied by physiological changes - conflict or overload of these may lead to disease - a sensitive, weak organ may contribute (locus minoris resistenciae) - association between the emotional conflict and the autonomic response- learning. - pathological activation

Neurosis-based (e.g Bykov)- psychophysiological model

- full or partial suppression of emotional reactions (self-evaluating hostility) - the organism remains in permanent readiness - frequent occurance or permanent subsistence leads to organ dysfunctions.

Endocrine diseases

- hyperthyreosis - diabetes mellitus (some forms)

Respiratory system diseases

- hyperventillation syndrome; - bronchial asthma - upper respiratory tract inflamations

Reproductive system diseases

- impotence - menstruation disorders - frigidity

Diseases were regarded as complicated functions determined by

- inherited factors, - perinatal complications, - organic infant diseases, - d. characteristics of infant care, - random physical traumas in infant - and childhood, - f. occasional emotional traumas - g. later emotional experiences, - h. emotional climate and relationships of the family, and - later physical injuries d,f,g,h = elements of the so called psychogenesis

Gastro-intestinal system diseases

- peptic ulcers; - irritable bowel syndrome (colitis mucosa, IBS); - colitis ulcerosa and Crohn-disease (inflamatory bowel diseases -IBD) - incontinency and other anal disorders - obesitas - anorexia and bulimia nervosa

Motor system diseases

- rheumatoid arthritis - low and high back-pain

Conflict specificity (Alexander) - psychoanalytic model

- suppressed anger⇒circulatory system, - dependent search for help⇒alimentary functions, - conflict between dependency and sexual desire ⇒breathing functions

Immune system diseases

- thyreotoxicosis - cancer

Skin diseases

- urticaria - excess sweating - rosacea - pruritus (itching) - acne - neurodermatitis - psoriasis - allergies

A disease model of Alexander

1. A specific conflict makes the patient vulnerable toward certain diseases but only in the presence of certain genetic, biochemical and physiological factors (X-factors). 2. In certain specific life-situations, to which the patient had become vulnerable by the specific key-conflict, the conflict again appears and becomes stronger. 3. The activated conflict is accompanied by strong emotions which can change functioning and structure via autonomic, hormonal and neuro-muscular ways.

Learning and social reinforcement

IBS - characterized by lower abdominal pain, general pressures of pain in the stomach, dizziness ++ - Associated with movement problems of the large intestine, either it moves too fast or too slow - No genetic background, strictly learned - IBS linked to menstrual dysfunction

Organovulnerability (E.g Adler) - psychoanalytic model

There are some internal organs that are inheritedably weak

Boarder problems (skin disorders)

This kind of disorder is one of the problems which results in skin disorder. - A new man enters the family, the child hates the man, the man tries to come closer, the child doesnt want to = develop skin problems

Shaking events (cancer)

May contribute to the development of cancer. Most of the lung-patients were older females, who recently had experienced the loss of their spouse

Genetic disposition and environmental factors

Some genetic factors may be responsible for some diseases. Typical disease is. hypertension. There is a connection between genetics and environment - borderline hypertension.

Multifactorial origin

Most psychosomatic diseases have this multifactorial origin. Myocardial infraction is one of the most frequent disorder causing death. There is no single cause behind this disease. Risk factors into three categories: 1) biomedical reasons, 2) behavioral and psychological factors, 3) sociological factors (e.g type A personality)

Causation relationship - chicken and egg

What comes first? - IBD is a very serious, complicated disease. - Difficult to trea; pharmacological treatment not very successful - Personality changes > consequences of the disease - Looks like the chicken (psychological disposition) was first, and the egg (disease) last

Engel´s bio-psycho-social model

• Health, non-health and disease are relative and multifactorial states. • 2. Functional disturbances of the organism may be completely or partially hidden. • 3. Diseases, disorders and their consequencies always have social, psychological, developmental and physiological components and cannot be studied only by pathophysiology or pathology. • 4. Disease is an adaptation on a different level or a bankrupcy through defective organisation. • 5. The aim of the therapy should be correcting defective adaptation. • 6. Health - according to these - means complete well-being both in individual and environmental respect - i.e. it means homeostasis; whereas disease is then a disturbeance of homeostasis.

The classic seven (Alexander)

• peptic ulcer, • asthma bronchiale, • rheumatoid arthritis, • colitis ulcerosa, • essential hypertension, • neurodermatitis, • thyreotoxicosis.