Psychosomatic Disorders
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1 Psychosomatic Disorders
2 Psychosomatic Disorders BENJAMIN B. WOLMAN Editor-in-Chief International Encyclopedia of Psychiatry, Psychology, Psychoanalysis, and Neurology PLENUM MEDICAL BOOK COMPANY NEW YORK AND LONDON
3 Library of Congress Cataloging in Publication Data Wolman, Benjamin B. Psychosomatic disorders I Benjamin B. Wolman. p. cm. Includes bibliographies and index. 1. Medicine, Psychosomatic. I. Title. [DNLM: 1. Psychophysiologic Disorders. WM 90 W865p] RC49.w dc19 DNLM/DLC for Library of Congress CIP ISBN-I3 : DOl: / e-isbn-13 : Plenum Publishing Corporation 233 Spring Street, New York, N.Y Softcover reprint of the hardcover 1 st edition 1988 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical. photocopying, microfilming, recording, or otherwise, without written permission from the Publisher
4 Preface This volume is an encyclopedic book on psychosomatic disorders, written for neurologists, psychiatrists, psychologists, psychiatric social workers, and other mental and physical health professionals. It could be used as a textbook in advanced training programs for the above-mentioned professions. It covers the entire field of mind-body issues in psychology and psychiatry and related areas of clinical medicine. The mind-body relationship is a two-way street. Anxiety, fear, anger, and other emotional states can produce physiological changes such as tears, elevated heart rate, and diarrhea. When these changes affect one's health, they belong to the province of psychosomatic medicine. On the other hand, the intake of alcohol and other substances can affect such psychological processes as thinking and mood. When the intake of substances is helpful, they belong to the province of psychopharmacology. The substances that are hurtful and adversely affect one's mental health belong to the category of addictions and drug abuse. All these issues are somatopsychic. The present volume does not deal with somatopsychic phenomena no matter what effect they may have. It deals with the physical effects of psychological issues, and only with those that cause harm to the human body. Thus, it describes and analyzes psychosomatic disorders. It is divided into four major parts: theoretical viewpoints, etiological considerations, the psychosomatic diseases, and treatment methods. I am greatly indebted to my two research assistants, Mahala Buckingham-Clark and Susan Friedman, for their most efficient cooperation. I am also grateful to the editorial and production staff of Plenum Publishing for their cordial and most encouraging attitude. BENJAMIN B. WOLMAN v
5 Contents PART 1. FOUNDATIONS Chapter 1. Conceptual Framework... 3 Defining Psychosomatics Homeostatic Approach Conscious and Unconscious... 5 Psychology and Physiology References Chapter 2. Historical Overview... 9 Ancient Ideas Modern Times... 9 Psychophysical Parallelism The Beginnings of Psychosomatic Medicine References Chapter 3. Psychoanalysis Sigmund Freud Alexander's Theory Other Psychoanalytic Approaches References Chapter 4. Neurophysiological Approach Cannon and Selye Alexander Specificity of Emotional Factors in Psychosomatic Disturbances.. 31 Corticovisceral Medicine Current Research References Chapter 5. The Immune System Anatomy and Physiology of the Immune System Autoimmune and Antiautoimmune Diseases vii
6 viii Psychological Aspects References Chapter 6. Monistic Transitionism The Concept of Change PsychosomaticSyr.nptoms A Few Cases Psychosomatic Pseudopregnancy Psychosomatic Heart Trouble Encopresis Pubic Area Skin Rash Throwing Up References PART II. ETIOLOGICAL CONSIDERATIONS Chapter 7. Stress Defining Stress Stressors Prolonged Stress Response to Stress Appraisal and Coping Conceptual Evolution References Chapter 8. Conditioned Reflexes Pavlov's Theory Unconscious Motivation Heart Rate and Conditioning Operant Conditioning References Chapter 9. Sociocultural Determinants The Basic Drives Equilibrium and Constancy The Psychophysiological Link Stressful Situations Migration References Chapter 10. Parents and Children Parental Attitudes The Impact of Divorce The Mother-Child Relationship
7 ix The Choice of Symptoms Socioeconomic Factors References Chapter 11. Personality Types A and B Types Genetic Predisposition References PART III. THE DISORDERS Chapter 12. Hypochondriasis Definitions Etiology Hypochondriasis and Depression Hypochondriasis and Personality Type References Chapter 13. Asthma Defining Asthma Incidence Etiological Studies "Conditioned" Asthma Emotional Factors Parental Attitudes Inner Conflicts References Chapter 14. Gastrointestinal Diseases Anorexia Nervosa Bulimia Anorectic Families Gastric Neurosis Ulcers Ulcers in Children Ulcerative Colitis Irritable Bowel Syndrome Encopresis Diarrhea Obesity Affiliation Motive and Depression Parent-Child Relationship Body Image Obesity and Schizophrenia References
8 x Chapter 15. Cardiovascular Diseases Etiology Coronary Heart Disease Family Background The Work Environment Essential Hypertension: Symptoms Psychological Factors Essential Hypertension: The Nervous System Mitral Valve Prolapse Various Cardiovascular Diseases References Chapter 16. Skin Diseases The Vital Functions Anatomy and Physiology Skin and Psychosomatics Allergies Dermatitis Neurodermatitis Pruritus Anogenitalis Infantile Eczema Urticaria (Hives) Acne Hyperhydrosis Rosacea Psoriasis Delusional Parasitosis Self-Imposed Skin Diseases References Chapter 17. Psychosomatic Aspects of Cancer Symptomatology Lung Cancer Breast Cancer Multiple Myeloma Leukemia Liver Cancer Kidney Cancer Stomach Cancer Cancer of the Uterus Prostate Cancer Etiology Genetic Factors: Male and Female Cancer Ratios The Hammer-and-Anvil Interaction
9 xi Psychosocial Factors Emotional Factors Premorbid Background The Course of the Disease Prognosis Resilience A Case Description References Chapter 18. Pain Survival and Power Elation and Depression The Purpose of Pain Pain and Pleasure The Posthedonic Level: The Antigone Principle Physiological Aspects of Pain Naloxone Psychosomatic or Somatopsychic? Attitude toward Pain Reaction to Pain Theories of Pain Headaches Tension Headaches Other Pains References Chapter 19. Psychosomatic Issues in Sexuality and Gynecology Psychoanalytic Interpretation Sexual Inadequacy Sexual Disorders in Organic Diseases Gender Identity and Role Homosexuality Pregnancy Postpartum Depression Menopause References Chapter 20. Psychosomatic Issues in Diabetes, Arthritis, Thyroid Diseases, Muscular Tensions, and Infectious Diseases The Immune System Diabetes Mellitus Osteoarthritis
10 xii Rheumatoid Arthritis Backache Diseases of the Thyroid Gland Thyrotoxicosis Hyperthyroidism Hypothyroidism (Myxedema) Muscular Tensions Infectious Diseases References Chapter 21. Psychosomatic Issues in Mental Disorders Anxiety School Phobia Conversion Hysteria Depression Etiological Factors References Chapter 22. Mental Disorders: Schizophrenia Genetics Neurochemistry Endorphin Neurophysiology Stress and Schizophrenia Sociopsychosomatic Theory Downward Adjustment Mental Processes Conditioning Analgesia The Schizophrenic Paradox References PART IV. TREATMENT METHODS Chapter 23. Basic Premises Etiological Considerations General Rules References Chapter 24. Differential Diagnosis Nosology: Classification of Diseases Therapeutic Considerations Diagnosis and Behavioral Methods Prognostic Considerations
11 xiii Psychosocial Field Kimball's Diagnostic Method Diagnostic Difficulties Some Recent Developments References Chapter 25. Psychoanalytic Methods Free Association Resistance Transference Insight Alexander's Technique Treatment of Ulcers Treatment of Colitis Alexithymia References Chapter 26. Behavior Therapy The Various Approaches Token Economy Programs Goal-Directed Behavior Systematic Desensitization in the Treatment of Psychosomatic Disorders Discrimination Training in Exacerbated PsychosOI;natic Cases Behavioral Skills Training Behavioral Treatment of Anorexia Behavioral Treatment of Obesity Behavioral Treatment of Sexual Disorders A Case Description Treatment of Coronary Heart Disease Treatment of Pain Treatment of Irritable Bowel Syndrome Treatment of Dermatological Disorders References Chapter 27. Interactional Psychotherapy Transference Courage and Wisdom: The Purposes of Interactional Psychotherapy Becoming: Self-Realization Psychosomatic Disorders Hypochondriasis Cardiovascular Symptoms..., References... " 285
12 xiv Chapter 28. Biofeedback, Autogenic Therapy, Meditation, and Hypnosis Biofeedback Biofeedback Therapy Clinical Biofeedback Training Biofeedback and Psychosomatic Disorders Tension Headaches, Bruxism, and Asthma Gastrointestinal Symptoms Cardiovascular Symptoms Autogenic Therapy States of Consciousness A Case Report Meditation Hypnosis References Chapter 29. Coping Defining Coping Cognitive Appraisal Outcomes of Coping Prevention of Psychosomatic Disorders References Author Index Subject Index
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