Psychosomatic Disturbances Research Articles

An Operationalized Multisymptomatic Model of Neuroses (OMMON): toward a reintegration of diagnosis and treatment in behaviour therapy.

Experimental results from a sample of 216 patients with four different "symptom-neuroses" show that 65% to 90% of these patients have different combinations of multiple symptomatology. With a background of these data, we present an Operationalized Multisymptomatic Model of Neuroses (OMMON), based on self-rating assessment of these patients on 4 symptom scales. Individual ratings on each scale are dichotomized into (+) or (-) results with regard to defined cut-off points and the model is derived from their 16 mathematically possible combinations. Subsequent analysis of these data (from a single test application) with our Varying Cut-Off Point Assessment (VACOPA) leads to hypotheses regarding causal symptom interactions and prediction of symptom changes over time, easily evaluated by repeated test application. In treatment research the model seems suitable to: (a) build more homogeneous diagnostic groups; (b) operationalize varying degrees of "neurotic" disturbance, from "normal" via "client" to "patient"--independently of existing illness theories; (c) support prognoses of individual developments within and without treatment; (d) specify treatment aims and optimal sequences of interventions; (e) monitor predicted outcome; (f) reconsider earlier apparently contradictory outcome studies; (g) evaluate theoretical concepts regarding "neurotic" symptom formations in neuroses, psychoses, and psychosomatic disturbances. For treatment purposes, OMMON should only be used together with "clinical" hypotheses; its prognostic potential can be increased by additional application of our Operationalized Multivariate Model of Motivation (OMMOM). All three diagnostic approaches may be used for mutual evaluation.

“Get Sick” as an Escape Hatch

Illness (Get Sick) is included as an escape hatch together with insanity, suicide, and homicide. Get Sick is presented as the somatic counterpart of Go Crazy. Opening Nurturing Parent is suggested as the route to prevent diversion of energy to psychosomatic disturbance. The therapeutic goal of wellness is derived through a personal commitment to protect and enjoy life.

Cycle disturbances, psychosomatic complaints, and self-image: an analysis of interdependencies between self-perception and psychosomatic disturbances

A coincidence of psychosomatic vulnerability and cycle disturbance led us to attempt to identify the origin of what appears to be a consistent pattern of psychosomatic susceptibility. Self-esteem, as measured by the discrepancy between the Ego-ideal and the perceived self-image, seems to play a substantial role in the relationship between psychosocial conditions and cycle disturbances. The association between self-esteem and psychosomatic vulnerability offers an approach for the study of several questions: To what extent is self-esteem socially transmitted, and thus to what extent can the degree of psychosomatic reactions be viewed as the result of socialization processes?

Interactions between psychosomatic conflicts and gonadotropin secretion.

This present paper represents an attempt to correlate hormonal patterns and psychoanalytical data in 30 patients with secondary amenorrhea. Based on psychoanalytical data and the maximal LH response to GnRH, which were obtained independently, the patients were divided into two groups presenting differing psychosomatic symptomatologies. Patients with severe psychosomatic disease (group A) complaining predominantly of somatic discomfort, exhibited a weak pituitary response to GnRH. Patients presenting mainly mental symptoms were found to be less affected by the psychosomatic disease (group B). The LH responses to GnRH were only moderately impaired in these patients. Seven patients of group A underwent psychotherapy, resulting in a resumption of regular menses in 4 patients. Eight untreated controls of this group who remained amenorrheic exhibited unaltered gonadotropin in levels. All patients of group B being treated by psychotherapy resumed regular menses, while 5 of 7 control patients developed spontaneous menstruation. The progress of sexual maturation in these patients is correlated with increasing pituitary LH response to GnRH. The present study provides evidence that the degree of a psychosomatic disturbance resulting in secondary amenorrhea is reflected by the pattern of plasma LH after GnRH stimulation.

Psychosomatic Disturbances and Tragic Script Payoffs

Cautions that closing, by decision of the Adult ego state, of the “escape hatches” of killing, going crazy, or committing suicide, leaves underlying script issues and Child (C2) conflicts unresolved. The increased turmoil and stress within the Child may be manifested as somatic disturbances. The necessity for diligent monitoring by the therapist for possible somatic changes, and the paying of appropriate therapeutic attention to the related script issues are emphasized.

The liver and depression

There are to be found in Hahnemann's work ideas which appear to me to be still full of untapped potentialities. One of his most valuable indications is the concept of one-sided diseases. Whereas, he points out, most disorders have some local or somatic aspect intermixed with mental or emotional disturbances, there are cases in which the symptomatology is so one-sided that it is almost completely either local or else mental. There are cases in which even severe disease, gross pathology, occurs in some organ whilst the personality remains to all around normal. It is not uncommon to find patients with quite advanced malignant tumours of some organ who yet still feel in themselves well and manifest no change in behaviour or emotional balance. Again in the so-called mental diseases, such as the schizophrenias, the symptomatology is one-sidedly in the mental sphere and it is not easy to localize it in some organ, even the brain. In such cases physical health may continue over many decades whilst the personality becomes progressively crippled. These two polar extremes of one-sided disease set, as it were, the limits of a spectrum of psychosomatic and psychoneurotic disorders spread out between them. In 1963 the Bahnsons, working on the psychosomatic aspect of malignant disease, put forward a disease spectrum. On one side they pointed to a progression from conversion hysteria through hypochondriacal conditions and psychosomatic disturbances to the somatic diseases and ultimately to cancer. On the other side of the balance the progression indicated was from anxiety hysteria through anxiety neurosis to the phobias and obsessive and compulsive neuroses, and then to the paranoid and deteriorated psychoses. The similarity of this attempt to Hahnemann's seems to me obvious and in need of no further development on this present occasion. They both however demand that we should attempt to build bridges from one side of the psychosomatic, psycho-neurotic balance to the other. One particular instance of this immensely demanding task is the problem of the psychic connections of particular organs. Today it is the liver which is the centre of our considerations. Now where can we look for clues from which to start? Two come immediately to hand. Firstly there is the common experience of infective hepatitis. Whoever has experienced this disease can usually tell of the intense depression which commonly ushers it in and which is often somewhat alleviated when the frank jaundice manifests. Secondly there are the varied symptoms of illness which

Pathological primary identifications and their effects on the psychosomatic economy of the individual.

The paper deals with the problem of the unstable psychosomatic economy and the patient's consequent susceptibility to psychosomatic disturbances. This goes back to a primary psychobiological defect in the sphere of his earliest identifications, which comes to the surface in emotional crisis situations. The term "Psychosomatic Phenomenon' is used to describe this basic disturbance in the patient's relationships, which can be observed in his interactions with the psychotherapist or interviewer, where it takes the form of a noticeable lack of fantasy, poor relationships and a reduced capacity for psychic experience and elaboration. The author's object-psychological approach has grown out of years of experience in the analytical treatment of hospitalized psychosomatic patients. A 'toxic environment' can be seen to have been a disturbing influence on the early development of the infant. A child whose mother herself knows no autonomy cannot develop its own fantasies through autoerotic activity and thus cannot build up a libidinal object in its inner world. The result is that such an individual is incapable of meeting the inevitable somatic disorganizations with differentiated reorganization processes and so has no defense against physical illness.

Split Brains and Psychoanalysis

Modern neuro- and psychophysiological findings on commissurotomized ("split-brain") patients seem to confirm psychoanalytic theories. Twelve commissurotomized patients and one patient who had a right hemispherectomy showed an impoverishment of dreams, fantasies and symbolization. This might have been due to an interruption of the preconscious stream between the two hemispheres, which causes a separation of word-presentations from thing-presentations, as well as to a predominance of a feedback-free primary process in the right hemisphere. The similarity in operational thinking of psychosomatic and split-brain patients leads the author to hypothesize a "functional commissurotomy" in cases of severe psychosomatic disturbances.

The psychosomatic approach in the practice of medicine.

The psychosomatic approach requires of the practitioner broad knowledge and skills relevant to the psychosocial, metabolic and physical responses of patients. The approach, being holistic, becomes appropriate in many different clinical situations (and should not be restricted to a few so-called psychosomatic diseases). Wise physicians and perceptive laymen have recognized the validity of an holosomatic approach for over 4000 years. Although the prevalence and incidence of psychosomatic disturbances are difficult to estimate (and probably underestimated in many surveys), data support the statement that family physicians should employ a psychosomatic approach in at least 15 per cent of cases. The general internist will probably encounter primarily psychosomatic disturbances in about 30 per cent of his patients; for example, many common presenting symptoms such as fatigue and chest pain arise in a setting of psychological stress. Apart from a sound knowledge of the genesis and manifestations of metabolic and structural changes, the physician must be familiar with the causes and symptoms of psychological disorders. Skillful interviewing and histroy-taking provide the data necessary to analyze and unravel psychosomatic interplay. Psychotherapeutic interviews often enable both the patient and the physician to understand the clinical problem: this understanding appears to aid recovery.

Effect of the renin-angiotensin system on sodium appetite

Publisher Summary This chapter discusses the effect of the renin-angiotensin system on sodium appetite. Saline consumption by rats depleted of sodium by intraperitoneal dialysis, given a two-bottle choice test of water and 1 % NaCl solution, was reduced during the 3 h following bilateral nephrectomy compared with unoperated controls. The water intake of thirsty rats was not affected by nephrectomy. Unilateral nephrectomy as well as ureteric ligature did not affect sodium intake. The effect was dose-dependent. The kidneys might, therefore, play a role in the regulation of sodium intake via the renin-angiotensin system. In addition, the chapter also highlights the physiological mechanisms involved in psychological stress. Physiological mechanisms underlying stress are identical in man and animals. Psychological stress arises in man due to the effect of various factors on the neocortex and experiments in animals have shown that deep and prolonged psychosomatic disturbances arise from psychological stress.

Einige Überlegungen zur Psychodynamik der Ulkuskranken anhand des Giessen-Tests

Using the Giessen-Test in a series of investigations among ulcer patients our findings are compared with the psychodynamic personality characteristics of ulcer patients as reported in the literature. We were able to confirm identity of the contents. Special attention, however, is directed toward a few surprising results which appear incompatible with the prevailing concept that ulcer is of ‘neurosis-psychological’ orientation. On the basis of other observations in the literature, we interpret these findings as related to limited achievement capacity of the psychic defense organization of ulcer patients. Whether this Ego-psychological aspect is of general importance for patients with psychosomatic disturbances and whether it represents, perhaps, one of the ways of access to the specifically ‘psychosomatic phenomenon’ of these diseases, are the final points under discussion.

Environmental Education: The Central Need

T HE INCREASING INTEREST in envirornental education has resulted in the proliferation of an enormous quantity and variety of curricular materials. These materials have been generated by many groups with differing aims and concerns: private industries pursuing their own interests, conservation groups claiming to serve the public good, and others. Some materials build on the tradition of outdoor education; others emphasize conservation, ecologic, or social themes. Few support comprehensive, integrated curricular program. For the most part they are segments of programs-conceptual outlines, helpful hints, student handouts and study materials, approved teaching methods, and so on. The materials tend to be focused around crisis issues, such as overpopulation, pollution, and resource depletion; but seldom are these contents combined into single, coherent package. Does this outpouring of materials have any educational merit? Is there something in the movement that is durable and worth preserving, that cuts across the limited specialties of its myriad programs? Or is the environmental push into education merely what Stillman (1972) has called a symptom of psychosomatic disturbance in the body politic? Superficially, the field appears too fractionated to be readily integrated, but closer examination reveals number of interconnected themes and shared perception of the world and of man's place in it. These can provide the basis for consolidating the best in environmental education. The environmental thrust in education is motivated by an apparent recognition of closed-system aspects of the spaceship Earth-a recognition that, for the foreseeable future, man is bound within system that allows neither entry nor departure. Every decision or activity is approached by the environmentalist from within the framework of the laws that govern such system. Environmental education foresees limitations to human exploits and system of guiding principles not quite divine but of considerably greater import than simple cognitions. Differences and disagreements are rampant, but this shared perception is unifying initial referent.

Clonic hemifacial spasm and partial neurectomy as its treatment

Clonic hemifacial spasm is a fairly common disease. Though not a painful condition still it needs treatment, as it leads to severe psychosomatic disturbances. Non surgical treatment is not much of use to relieve the condition. Patients though intially averse to idea of total paralysis are found to be willing subject when they are subjected to temporary paralysis by zylocain injection at the stylomastoid foramen. Partial neurectomy a procedure done in the fallopian canal is described. It gives relief from spasm with minimal paralysis.Even then clinician feels often “guilty” of having “missed” something as in most of them cases causal factor is not detected inspite of extensive investigations.

The family as a factor in psychosomatic disturbances.

Psychosocial dynamics within the family are first touched upon. The physician should watch the signs and helpingly intervene. He has to acquire a valid picture of the family unit with its strengths and shortcomings in mind and body. Continued flight from pressure of vital issues can lead to family neurosis in the long run. How then, when an ill person is not really the carrier of disease in a causal-genetic sense? If he himself is only a ‘symptom’ of a much more widely encompassing disease unit that has grasped a social union like a family. Are we physicians and scientists in a position, as a consequence of our training, to see this possibility, or are such modes of thinking to be left to special medical fields like medical sociology? The isolated, sick person can show signs derived from a disturbed family relationship, particularly through psychosomatic disorders. Our therapeutical method of ‘psychosomatic confrontation’ is introduced.

The Worldwide Wage Explosion

DURING THE DECADE PRIOR TO 1968, most of the industrial countries of the West experienced a period of tranquility in which prices were relatively stable and wage inflation moderate. Then quite suddenly-and, to judge from professional and political reaction, unexpectedly-wages and prices began to rise very sharply. Figure 1 shows the pattern of inflation for manufacturing wages from 1956 to 1971; the break in the trend in 1968 and the ascent to the peak in 1970 are clearly discernible. The wage histories of the seven countries to be considered in this paper are shown in Table 1.1 In each, wage inflation during the last four or five years rose noticeably over earlier years in the sixties. The wage explosion has tested the ingenuity of economists, and they have not been found wanting. Countless discontinuous time series and special forces have been discovered to explain this surprising movement. But the diagnoses have a suspicious character. It is as if the doctors in a town hit by a plague all cite special factors to account for it: a cold, pneumonia, the population explosion, barometric pressure, in-laws' interference, psychosomatic disturbances, and so forth and so on. Isn't it curious that all the special factors hit all the countries at the same time?

Hormonal vs. Psychosomatic Disturbances of the Menopause

Hormonal vs. Psychosomatic Disturbances of the Menopause

Re-evaluation of the concept of psychosomatic disturbance.

The purpose of this paper is to attempt once more to grasp the totality of our existence. Emphasis is placed on the phenomenological approach which shows the individual's particular mode of existing or relating-in healthy and in sick ways—which encompasses mental, spiritual and corporal aspects. Two cases were presented which showed endocrine and emotional disorders. The first case is of a woman who developed acromegaly; the second, a man who suffered from hypogonadism, a possible pituitary involvement with a picture resembling Frohlich's Fat Boy and diabetes mellitus. In describing these two cases I pointed out the intricate interplay of many interrelated factors such as hereditary-constitutional and familial factors, body build, character structure, developmental occurrences such as recurrent traumas, the current life situation. physical and mental problems, etc. Emphasis is placed on the mode of existing, be it in a mode of hunger, dread or depression and resignation. The detrimental effects of unresolved conflicts and their sequels, as written about by Horney and Kelman, are self-evident in both cases; so is their accessibility to psychoanalytically inclined psychotherapy and the beneficial effect of it.

Beginning psychiatry training syndrome.

The psychological response of the resident to his first year of psychiatric training may be characterized by temporary neurotic symptoms, psychosomatic disturbances, and symptomatic behavior. The recognition of this beginning psychiatric training syndrome as a transient and often valuable adaptational response may lessen its intensity and encourage both the resident and his instructors to deal with it more constructively.

Unwanted conception: research on undesirable consequences.

Literature is reviewed which bears on the general hypothesis that unwanted conceptions have undesirable results for parents and children. In a large national probability sample, 17% of all white couples were classified as having excess fertility. Among couples married 10 years or more, 23% had excess fertility. Among nonwhites, 31% of all couples and 48% living on Southern farms had excess fertility. The hypothesis is raised that pregnant mothers' conscious or unconscious anger and upsetness during pregnancy make them more liable to the psychosomatic disturbance than mothers following conceptions that are not unwanted. Studies have been mixed in supporting the hypothesis. Psychological factors may, in some cases, lead to spontaneous abortions. No systematic research has been found that demonstrates a relationship between unwanted conception and spontaneous abortion although such a possibility seems plausible. There is little direct evidence of a link between unwanted conception and labor and delivery problems. The negative consequences of induced abortion provide a clear argument for attempting to avoid unwanted conception. Current views regard parapartum psychoses as cynamically similar to emotional upheavals at any time. Of 212 wives, those who reported having deliberately tried to avoid conception recalled significantly more emotional upset during the first trimester of pregnancy but similar differences were not present for later trimesters nor the period since childbirth. Although there is a contention that unwanted conceptions tend to have undesirable effects, direct evidence of such a relationship is almost completely lacking, except for a few fragments of retrospective evidence. This is primarily because there is little decisive reserach, rather than because of negative feelings.

Psychosomatic and Emotional Disturbances. A Study of Mother-Child Relationships

Psychosomatic and Emotional Disturbances. A Study of Mother-Child Relationships