Features of therapy for non-organic syndromes
The exclusive use of symptomatic medications—antスパзмолитиков, analgesics, β-blockers, antihypertensives, or hormones—for non-organic pain syndromes, palpitations, and sleep disorders generally yields no results. The indicated approach is a combination of psychotherapy and psychopharmacotherapy.
A telling clinical case is that of a 43-year-old businessman with a gastrointestinal psychosomatic disorder.
- Premorbid background: family history unremarkable (father abused alcohol), showed aggression in youth, envied top students, received allowances for social work. Later married successfully and started his own business.
- Trigger: conflict between a prestigious civil service position and a stable business (management demanded a choice).
- Clinical presentation: stress induced frequent false urges to defecate and fear of incontinence. Restrictive behavior developed—the patient mapped out all restrooms along his commute and avoided unfamiliar places. Gastroenterologists revealed no somatic pathology.
- Therapy: the patient denied the psychological nature of the illness. The physician prescribed the antidepressant clomipramine and applied the method of paradoxical psychotherapy (intention)—prescribing him to go to the toilet at the first sign on weekends and stay there until achieving the result.
- Outcome: complete resolution of urges without relapses.
Personality-mediated disorders
Certain types of pathologies are more common in individuals with specific accentuations or psychopathies, even outside of acute stress:
- Trauma. Impulsive individuals with an active character (excitable, hyperthymic, epileptoid), prone to adventures, are at high risk. Low risk is characteristic of cautious, anxious-suspicious people (pedantic, introverted, dysthymic).
- Obesity. Predisposing factors include cycloid temperament and pyknic constitution. According to psychoanalytic concepts, obesity sometimes serves as a psychological defense—a subconscious desire to push a partner away.
- Addictions. Anxious-suspicious personalities use alcohol and tranquilizers to compensate for insecurity. Excitable personalities drink due to weak willpower, infantilism, and a tendency toward antisocial acts.
- Abuse of routine medications. Unfounded intake of laxatives, antihypertensives, or anti-inflammatory drugs is typical of stuck-up (paranoid) personalities. They tend to form overvalued ideas regarding the maintenance of their health.
Psychological stress hardiness
Patients cope with stressors differently. Hardiness (hardiness, according to S.C. Kobasa, 1982) is the ability to endure significant life changes and frustration (blockade of dominant needs) without detriment to health.
Factors reducing hardiness:
- Feeling of loneliness. Has the strongest correlation with poor hardiness. For example, widowers experience exacerbation of chronic diseases (up to fatal outcomes), and housewives experience psychosomatic issues due to social isolation more often than working women.
- Fear of change. Perception of innovations as a threat or unbearable responsibility.
- Job dissatisfaction. A sense of wrong career choice or impossibility of self-realization. Also, individuals whose income involves deception are prone to stress.
Factors increasing hardiness:
- Social connections. Support from family and colleagues.
- Job satisfaction. Especially in "helping professions" (educators, teachers, doctors).
- Perception of change as an opportunity. The ability to find opportunities in stress ("fishing in troubled waters").
- Internal locus of control. Belief in one's own strength. According to A. Bandura (1995), boosting patient confidence improves immunity and treatment outcomes for bulimia, arthritis, and heart disease.
- Religiosity. Reduces intrapersonal conflicts. Mortality among regular churchgoers is 2 times lower than the population average.
Briefly: answers to topical questions
What types of reactions to illness (nosogenias) are distinguished in clinical practice?
In clinical practice, reactions associated with overestimating or underestimating the severity of the disease are distinguished. The main types include:
- Hypernosognosia — overestimation of the severity and danger of existing disorders, mistaking normal phenomena for disease.
- Nosophilia — behavior characterized by excessive fascination with the treatment process and medical topics.
- Hyponosognosia — underestimation of the severity of the disease, avoidance of treatment, and playing down the degree of the disease's impact on everyday life.
- Anosognosia — complete denial of the illness or euphoria.
What is the method of paradoxical intention in the treatment of psychosomatic disorders?
The essence of the paradoxical intention method is that the patient is artificially made to perform the behavior they want to get rid of. As a result of this prescription, habitual automatic actions cease to bring the desired emotional release. This forces the patient to look for a new, more productive way of resolving the internal conflict. For example, in a psychosomatic disorder with frequent urges to defecate, the doctor may prescribe the patient to go to the toilet on demand during weekends and stay there until defecation is achieved.
What forms of distortion of the illness image by the patient exist?
Distortion of the illness image by the patient is classified into conscious and involuntary.
- Conscious distortion — targeted deception of the doctor, including malingering (intentional demonstration of signs of a nonexistent disease), aggravation (deliberate exaggeration of painful sensations), and dissimulation (concealment of disease symptoms).
- Involuntary distortion — requires increased attention from the doctor and includes exaggeration of the disease severity (hypernosognosia, nosophilia) or its underestimation (hyponosognosia, anosognosia).
Class and exam questions
What is included in the inner picture of disease?
The inner picture of the disease includes the patient's attitude toward their condition, the sum of painful sensations, emotional experiences, knowledge about the pathology, personal experience, and actions to overcome the illness.
What is conscious distortion of the illness image called?
Dissimulation—the intentional concealment of existing symptoms—belongs to the conscious distortion of the patient's illness image by themselves.
Why do symptomatic drugs work poorly in psychosomatics?
In non-organic disorders (e.g., sleep disturbances or heart palpitations), there is no structural organ damage. Symptoms are secondary to the psychological state, so psychotropic drugs and psychotherapy are the basis of therapy.
What else to study on this topic
- Mechanisms of action of paradoxical psychotherapy (intention) on restrictive behavior
- The connection between psychoanalytic defense concepts and the formation of eating disorders
- The role of the internal locus of control in modulating immune defense (A. Bandura's research)
- The phenomenon of forming overvalued concepts of a healthy lifestyle in paranoid accentuation
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