Somatoform Disorders

Mechanisms of development

For a long time, attempts were made to explain the pathogenesis of such diseases from two polar positions.

On the one hand, the psychoanalytic approach (S. Freud, F. Alexander), where the disease was interpreted as a physical reaction to a repressed childhood conflict. On the other hand, the physiological direction, based on the works of I.P. Pavlov and H. Selye's stress theory. According to Selye, chronic tension depletes protective reserves, provoking elevated blood pressure, adrenal hyperplasia, decreased immunity, and gastrointestinal ulcers.

Today, the integrative model dominates, taking into account both psychophysiological constitution and human psychological characteristics. The concept of locus minoris resistentiae (point of least resistance) plays a role, suggesting that under stress, the initially weakened organ suffers.

Classification of disorders (according to M. Bleuler)

There is no universally accepted single classification, however, in clinical practice, it is convenient to divide these conditions into three groups:

1. Classical psychosomatoses. These are true organic diseases: hypertension and peptic ulcer disease, bronchial asthma, rheumatoid arthritis, neurodermatitis, ulcerative colitis.
2. Psychosomatic dysfunctions. Short-term, reversible failures without gross organic pathology. These include functional disorders (tachycardia, extrasystole, hyperventilation syndromes), gastrointestinal disturbances (diarrhea, vomiting, aerophagia), dysuria, and sexual dysfunctions.
3. Personality-related disorders. Conditions associated with maladaptive behavior: obesity, predisposition to trauma, substance abuse.

Features of psychogenic pain

Pain syndromes of psychogenic origin must be clearly distinguished from cenesthopathies — extremely bizarre, distressing, and unusual sensations. Psychogenic pain is more often projected onto subjectively significant areas (heart, head, joints).

• Cardialgia. In depression, it is a persistent morning feeling of heaviness, a "stone in the chest." In the context of a panic attack, the pain is sharp, associated with the fear of death. Unlike angina pectoris, such pain is not relieved by nitroglycerin, but responds well to validol and sedatives.
• Headaches. They can occur due to muscle tension in the neck and scalp against the background of anxiety, or have a hysterical mechanism (autosuggestion).

Personality and predisposition (F. Dunbar's concept)

Researchers note a link between certain character traits and specific nosologies.

Principles of management in a somatic clinic

Many doctors underestimate the psychogenic factor in migraines, infertility, or endocrine pathologies, which explains patients' resistance to standard regimens. It is important to understand: psychotherapy does not replace antibiotics or antihypertensive drugs, but significantly increases their effectiveness.

Psychiatrists actively use the side effect profiles of psychotropic drugs to treat somatic conditions:

• Neuroleptics (e.g., sulpiride) normalize gastrointestinal motility, work as antiemetics, and relieve skin itching due to their antihistamine action.
• Benzodiazepines relieve muscle spasms.
• Antidepressants (TCAs), due to their anticholinergic effect, are useful in ulcers and bronchospasm, while SSRIs cope well with chronic pain syndromes.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Sleep disorders in mental and somatic diseases
• Differential diagnosis of insomnia in acute psychoses
• Features of sleep disorder therapy in dependence syndrome
• Sleep paralysis syndrome and Kleine-Levin syndrome
• The phenomenon of "secondary gain" from illness in a hospital setting

Other topics in "Chapter 16. Somatic disorders and disturbances of physiological functions as a manifestation of mental pathology"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.