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As Psychosomatosis are physical illnesses that originate from psychological impairments. Psychological stress can manifest itself in physiological diseases, which then constitute an independent complaint and necessitate appropriately adapted therapeutic measures. Those affected often experience considerable suffering, not least because the context between the psychological problems and their illness often remains undetected for a long time.
Definition
While the field of psychosomatics also includes physical complaints, which are caused by mental stress, but are purely functional in nature (somatoform disorders), the term "psychosomatosis" is more narrowly defined and refers exclusively to psychologically-related organ diseases. They must also be differentiated from psychosomatic problems that can arise as a result of an illness. The classification by psychoanalyst Franz Gabriel Alexander from 1950 provides a good overview of psychosomatoses. The classic psychosomatic diseases known as "Holy Seven" include:
- bronchial asthma
- High blood pressure (essential hypertension)
- Inflammatory bowel disease (e.g. Crohn's disease)
- Neurodermatitis,
- Rheumatoid Arthritis (Chronic Polyarthritis)
- Hyperthyroidism
- Gastric ulcers (ulcer ventriculi) and duodenal ulcers (ulcer duodeni)
Beyond Franz Gabriel Alexander's definition, psychological influences are also suspected in other physical illnesses, for example:
- Tinnitus,
- Migraine,
- Psoriasis,
- Hives,
- Obesity.
In the case of high blood pressure, it can initially be assumed that the symptoms are purely functional, which would speak against a classification as psychosomatosis, but in the further course impairments of the vascular structures and other organs can also occur. In addition to the "Holy Seven", there is a possible connection with mental stress in numerous other physical illnesses, but in most cases this is significantly less pronounced than with the "Holy Seven". In the broadest sense, the organic impairments resulting from eating disorders such as bulimia or anorexia are to be understood as psychosomatoses. However, according to the common definition, these are defined as mental disorders with physical consequences. The International Statistical Classification of Diseases and Related Health Problems speaks of "behavioral problems with physical disorders and factors".
The definition of "psychosomatosis" suggests a relatively simple causality of the physiological complaints. However, this is not in line with the approaches of modern psychosomatics, which assume a complex interaction between physical and psychological factors. With the complaints mentioned, a major influence of psychological stress on the development and the course can generally be assumed, but a one-sided causality, as it is based on the model of psychosomatoses, no longer corresponds to the current state of research.
Symptoms
The symptoms of psychosomatosis can vary greatly depending on how they are manifested. They range from imperceptible increases in blood pressure to changes in the appearance of the skin in atopic dermatitis, respiratory problems and coughing in asthma, abdominal pain, stomach pressure, diarrhea, nausea and vomiting in gastric ulcers and chronic bowel diseases to joint and limb pain in polyarthritis. Each form of psychosomatosis is characterized by its own specific clinical picture, which usually does not initially indicate the connection with psychological stress. However, those affected may find that with increasing stress and suffering, the intensity of the symptoms increases. In the case of eating disorders, the starting situation is somewhat different, since here the connection between the symptoms that occur and the eating disorders can usually be clearly recognized even by lay people.
Causes
The causes of psychosomatosis are by definition to be looked for in psychological stress. However, diagnosed psychological disorders (e.g. depression or anxiety disorders) and general psychological problems such as long-term stress or intense grief can be distinguished here. In most cases, the way in which soul suffering triggers the physical complaints has not yet been fully clarified. In some of the supposedly psychosomatic illnesses, physical influences have turned out to be far more decisive than originally assumed. For example, it is known today that a large part of gastric ulcers and duodenal ulcers are caused by the Helicobacter pylori bacterium and that psychological stress only plays a minor role here. However, it can be assumed that stress and emotional conflicts generally have an adverse effect on the immune system and therefore favor a pathological multiplication of the bacteria. Here the interaction between physical and psychological causes of the diseases becomes clear.
Diagnosis
The diagnosis of physical complaints can often be made relatively easily with the different forms of psychosomatosis. For example, every dermatologist will recognize neurodermatitis. A gastric ulcer or duodenal ulcer can be determined by gastroscopy and, if necessary, a tissue sample (biopsy). A lung function test is used to make a diagnosis of asthma and blood tests provide evidence of a possible hyperthyroidism, polyarthritis and chronic inflammatory bowel diseases. In order to diagnose the latter, an ultrasound examination of the abdomen is often also carried out. In addition, other imaging methods such as contrast-assisted X-ray examinations or magnetic resonance imaging can be used to ensure the diagnosis of inflammatory bowel diseases. There is also the possibility of a colonoscopy with taking a tissue sample, also to rule out tumor disease in the intestinal tract.
Although the various clinical pictures of psychosomatoses can be diagnosed reliably, what is usually not clear is the connection with the psychological problems of those affected. Accordingly, considerable difficulties can arise in the course of the therapy, since the actual cause of the complaints remains unknown.
Treatment
Effective medications are available to relieve physical symptoms in the various psychosomatic diseases, but they do not take the cause of the symptoms into account. For example, itchy rashes, such as those that appear in the context of neurodermatitis, can be relieved relatively reliably with anti-inflammatory and antiseptic ointments. However, the highly effective ointments based on glucocorticoids (colloquially "cortisone ointments") have a high risk of side effects, so that they can only be used for a limited period of time. However, the symptoms often recur after stopping the preparations. The situation is similar for most other psychosomatoses. There are various therapeutic - mostly medicinal - approaches to alleviating the symptoms, but there is always a risk of a new outbreak after the end of the therapy.
Given the influence of psychological factors on the development of psychosomatoses, it can be concluded that a cure can be achieved with the help of psychotherapeutic treatment. However, although psychotherapy has been shown to have a positive effect on the course of the disease in most cases, it is generally not possible to achieve a complete cure with its help alone, since the physical manifestations of mental suffering also require physical treatment. The best results can therefore usually be achieved with the combination of medicinal and psychotherapeutic treatment. For example, acute forms of a non-bacterial gastric ulcer can be treated on the basis of so-called proton pump inhibitors, while those affected also learn in accompanying psychotherapy how they can best manage or avoid stress and other psychological stresses. Here, for example, special relaxation techniques such as autogenic training, yoga or progressive muscle relaxation are very helpful.
In the case of psychosomatic asthma, a relatively reliable relief of the acute symptoms using so-called inhalers is possible, but psychotherapy can rather have a positive influence on the long-term course of the disease. In the case of neurodermatitis, psychotherapy is also a good adjunctive therapy, since stress has an unfavorable effect on the course of the disease and, as part of psychotherapy, those affected also learn how to better deal with the constant itching. Ultimately, psychotherapy offers at least a sensible addition to conventional therapy for all psychosomatoses; in some cases, in combination with conventional treatment, it can even bring about a complete resolution of the symptoms.
Naturopathy for psychosomatoses
In addition to the above-mentioned approaches to psychotherapy, naturopathy has a number of other treatment options for the various forms of psychosomatosis, whereby herbal preparations (valerian, hops, Bach flowers) and homeopathic remedies (especially Nux vomica) for stress relief are particularly worth mentioning. A change in diet or nutritional therapy can also have a positive effect. This applies in particular to the psychosomatic diseases in the digestive tract. Naturopathy assumes a complex interplay between mind and body in all symptoms, which must also be taken into account in the treatment. However, not only the effect of mental stress on the organism has to be taken into account here, but also in the case of supposedly purely mental suffering, research is also being carried out into possible physical causes. With certain psychosomatoses, accompanying physical treatment in the form of acupuncture, massages or manual therapies can certainly take place. Which measures from the broad spectrum of naturopathy are used ultimately depends on the individual symptoms of those affected. (fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
Swell:
- Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland: Psychosomatics (available on August 30, 2019), neurologen-und-psychiater-im-netz.org
- Christof Goddemeier: Franz Alexander: On the way to psychosomatics, Deutsches Ärzteblatt, 2014, aerzteblatt.de
- Franz Alexander: Psychosomatic Medicine: Basics and Fields of Application, De Gruyter, 3rd Edition, 1977
ICD codes for this disease: F54ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.
