A proposed psychosomatic etiologic model for rheumatoid arthritis

This model attributes rheumatoid arthritis to reduction or loss of muscle tone. It is hypothesized that tone is maintained via a neurological feedback loop consisting of a spontaneous (fusimotor) signal from the central nervous system (CNS), a return signal from the sensors and a toning signal from the CNS to the muscles. Frequency of return and toning signals are thought to be identical. Arthritis patients believed to react to psychological stress with increased fusimotor frequency (i.e. muscle tension) which over-stretches the sensing tissue. Because of this damage, the lower fusimotor frequency following the stress episode cannot elicit an adequate frequency response from the sensors and this leads to a matching decline in toning pulse frequency and hence muscle tone. Reduced vascular/cardiac tone lowers blood pressure triggering a compensatory hypervolemia. The resulting hypoxia increases vascular leakage causing tissue/lymph edema and pleural/pericardial/joint effusions. Regular ingestion of ephedrine is thought to increase fusimotor frequency and this reactivates the sensors re-establishing muscle tone.     

Neural substrates of implicit and explicit emotional processes: a unifying framework for psychosomatic medicine

There are two broad themes in psychosomatic medicine research that relate emotions to physical disease outcomes. Theme 1 holds that self-reported negative affect has deleterious effects and self-reported positive affect has salubrious effects on health. Theme 2 holds that interference with the experience or expression of negative affect has adverse health consequences. From the perspective of self-report these two traditions appear contradictory. A key thesis of this paper is that the foundational distinction in cognitive neuroscience between explicit (conscious) and implicit (unconscious) processes, corresponding to Themes 1 and 2, respectively, provides a unifying framework that makes empirical research on unconscious emotional processes more tractable. A psychological model called "levels of emotional awareness" is presented first that places implicit and explicit emotional processes on a cognitive-developmental continuum. This model holds that the ability to become consciously aware of one's own feelings is a cognitive skill that goes through a developmental process similar to that which Piaget described for other cognitive functions. Empirical findings using the Levels of Emotional Awareness Scale are presented. A parallel hierarchical model of the neural substrates of emotional awareness is presented next supported by recent neuroimaging and lesion work. The evidence presented in this review suggests that the neural substrates of implicit and explicit emotional processes are distinct, that the latter have a modulatory effect on the former, and that at the neural level Theme 1 and Theme 2 phenomena share critical similarities. The implications of this psychobiological model for research in psychosomatic medicine are discussed.     

Multiaxial diagnosis and the psychosomatic model of disease

Current medical diagnosis reflects the prevailing biomedical model of disease. A need exists for a new system of diagnosis that, instead, is based on the psychosomatic model. This article presents an analysis of the underlying framework of the multiaxial system developed in recent years for diagnosis in Psychiatry that indicates its relevance to the psychosomatic model. It goes on to describe a new multiaxial system of diagnosis derived from that analysis that allows diagnosis to be stated as a process of adaptation in the environment, which includes biological, psychological, and social factors. The practical application of this system to the broad range of medical illnesses is explained and illustrated. This multiaxial approach represents a first step toward, and a stimulus for, the development of a better diagnostic system that can provide one basis for the crucial transformation of medical care to reflect the psychosomatic model of disease.     

Interoception,conditioning, and fear: The panic threesome

The present article aims to illustrate and review evidence on how associative learning involving interoceptive stimuli (interoceptive conditioning) can lead to changes in physiological, emotional, and perceptual outcomes. We first outline a functional perspective on Pavlovian conditioning and provide a general introduction and historical background on interoceptive conditioning as a special instance of Pavlovian conditioning. Next, biological and learning accounts of panic disorder are discussed, followed by an analysis of which stimuli and responses may be most promising to model learning that is relevant to panic disorder. Finally, studies on interoceptive fear conditioning with respiratory stimuli are reviewed and discussed, and future directions are outlined.     

Psoriasis: psychosomatic aspects.

On the basis of the findings of this study it could be concluded that the hereditary proneness alone is not sufficient to cause the breakout of psoriasis. Only when additional causes intervene, the disease breaks out. The importance of stress and emotional factors in causation and precipitation of the disease is discussed. The traumatic emotional experience and the aggravation of disease as result of improper approach of the society towards the patient's illness is reviewed. The impact of the disease on the treating doctor and the doctor-patient relationship is reported. Means of prevention of the breakout of the disease and the proper approach of the doctor in treating his patient is suggested and specified.     

Behavior therapy for psychosomatic disorders

Because learned emotional or psychophysiologic responses are a factor in the causation of psychosomatic disorders, such illnesses lend themselves to treatment with behavior therapy. A behavior analysis must be done initially to establish a correlation between the psychological factors and the somatic illness. Then systematic desensitization, flooding, biofeedback, and other techniques are effective in most patients. The author discusses the application of behavior therapy for relief of asthma, essential hypertension, migraine, tension headache, neurodermatitis, and gastrointestinal psychosomatic reactions.     

Confidentiality in the age of HIPAA: a challenge for psychosomatic medicine

This review, a work project of The Standards and Ethics Committee of The Academy of Psychosomatic Medicine, examines the challenges posed for consultation-liaison psychiatrists as they struggle to maintain the trust between patient and physician while balancing compliance with the increasing complexities of confidentiality with the provision of enough information to our medical colleagues for good clinical care. The authors discuss the moral, legal, and ethical issues that arise from the many-layered state and federal regulations, especially the impact of the Health Information Portability and Accountability Act (HIPPA) and make recommendations for practical application in the clinical setting.     

Socialization and psychosomatic disease: an empirical study of the educational style of parents with psychosomatic children

Starting from the assumption that psychosomatic diseases are distinct from neuroses and different kinds of socialization tend to predispose to the two disorders, the educational style of parents with psychosomatic children (n = 79, 30 bronchial asthma, 19 ulcerative colitis, 30 atopic dermatitis) and with neurotic children (n = 51) was studied. Children and parents were given questionnaires on parental educational attitudes, techniques and goals. Significant differences were found on various dimensions, which indicate for example closer mother-child ties as well as father-child ties in the psychosomatic families. The results from this study are consistent with the concept of a restrictive socialization in psychosomatic families.     

Schizophrenia: A psychosomatic disorder?

Opinions regarding the nature of schizophrenia form a spectrum ranging from the belief that the condition is purely mental or psychologic involving an overwhelmed ego, to the Opinion that it is organic, probably an inherited metabolic abnormality resulting from a toxic disturbance of the brain. No demonstrable structural changes in the brain have been shown in controlled neuropathologic studies. Despite the extensive investigations of the condition, there have been relatively few individuals who have considered the possibility that schizophrenia might be a true psychosomatic disorder, that is, a condition in which the function of an organ (the brain) is disturbed or abnormal because of emotional stress or conflict, and in which the symptoms are the result of the organ's dysfunction. This paper proposes this thesis for further consideration.