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1. Psychosomatic Disorder
Nabina Paneru

2. Introduction
• Psychosomatic means mind and body.
• A psychosomatic disorder is a disease involving both mind
and body.
• Psychosomatic also called Psycho – physiologic disorder,
condition in which psychological stresses adversely affect
physiological (somatic) functioning to the point of distress.

3. Definition
• A group of mental ailments in which emotional stress is a
contributing factor to physical problems involving an organ
system under involuntary control.
- Bimala Kapoor, 1994
• Disorders in which psychic elements are significant in
initiating alteration in chemical, physiological or structure of
the individual resulting in physical symptoms.
- Sreevani R

4. Classification
Psychosomatic illnesses can be classified in three general forms:
• The first form includes those who experience both a mental illness and
a medical one; these illnesses complicate the symptoms and
management of each other.
• The second form includes those who experience a psychiatric issue that
is a direct result of a medical illness or its treatment; having depression
due to cancer and its treatment for example.
• The third form of psychosomatic illness is, 'somatoform,' disorders.
Somatoform disorders are psychiatric ones that are displayed through
physical issues.

5. Somatoform disorder
Somatoform disorders are mental illness characterize by the presentation
of physical symptoms with no medical explanations. The symptoms are
severe enough to interfere with the patients ability to function in social or
occupational activities.

6. Types of Somatoform disorder
1. Somatization disorder: Multiple somatic symptoms in absence of
any physical disorder. The symptoms are recurrent and chronic (at
least 2 year duration is needed for diagnosis). It begins before age 30.
2. Conversion Disorder: An expression of psychological conflict or
need that involves an alteration or loss of physical functioning that
suggests a bodily cause in the absence of a medical reason.

7. Contd.
3. Body Dysmorphic Disorder: An obsession or preoccupation with an
imaginary or minor flaw such as wrinkles, small breasts, or the size or
shape of another part of the person's body. Body dysmorphic disorder
causes severe anxiety and might impact a person's ability to function
as usual in their daily life.

9. Contd.
4. Hypochondriasis: Preoccupation with having or contracting a serious
disease in the absence of medial reason

10. Contd.
5. Pain disorder: Preoccupation with pain in the absence of an adequate
physical basis for it.

11. Etiology
1. Individual exhibit specific physiological responses to certain
emotions. E.g. in person to the emotion of anger, person may
experience peripheral vasoconstriction, resulting in an increase in
blood pressure.

12. Contd.
2. Personality Theory: individuals with specific personality traits are
predisposed to certain disease processes:
Personality Characters Psychosomatic disorder
1. Dependence personality  Asthma
2. Repressed, anger  Peptic ulcer and HTN
3. Aggressive, ambitious  Coronary heart disease
4. Compulsive and perfectionist  Migraine
5. Self sacrificing & inhibited  Rheumatoid arthritis &
ulcerative colitis

13. Contd.
3. Family Dynamic Theory: Pathogenic family pattern in childhood,
stressful and conflicting interpersonal relationship among family
members.
4. Biological theory: (Genetic predisposition): First degree relatives,
monozygotic twins are prone to develop psychosomatic disorders.

14. Possible progression of psychosomatic disorders
Prolonged anxiety
Persistent psycho – physiological reactions
Structural alteration, cellular disease and functional
impairment
Psychosomatic Disorders

15. Some Important Psychosomatic Disorders
1. Bronchial Asthma
Asthmatic symptoms are induced by emotional stress. Bronchial asthma is
common in fear, rejection, and mourning or pent op emotion, upset in
dependency need.

16. Contd.
2. Cardiovascular Disorders
- Hypertension, coronary heart disease (CHD). The most deadly and well
– known form of coronary heart disease is myocardial infarction (MI).
- Hypertension increases the risk for CHD, as well as other serious
disorders such as stroke.
- Type “A” personality is found to be linked with coronary heart disease
(CHD). Type “A” personality includes excessive ambition, high
performance standards, persistent urgency, competitiveness,
aggressiveness and hostility.

17. Contd.
3. Peptic ulcer
Stress and emotional disturbances  adreno – cortical secretion 
increased acidity  progressive erosion of the mucosal wall in
esophagus, stomach, duodenum or jejunum  increased inflammation
and severe laceration  ulcer

18. Contd.
4. Irritable Bowel Syndrome (IBS)
- Stress and anxiety may make the mind more aware of spasms in the
colon.
- IBS may be triggered by the immune system which is affected by
stress.

19. Contd.
5. Ulcerative colitis
- Patients with a predominance of compulsive personality traits, and
narcissistic personality traits, and are neat orderly and clean, punctual,
hyper intellectual and inhibited in expressing their anger are associated
with individuals who have ulcerative colitis.
- Disturbed personal relationship resulting in feeling off helplessness and
hopelessness
- Stress  Grief, anxiety, disappointment, guilt, frustration, emotion
suppression  triggers hypothalamic pituitary thyroid and adrenal axis
 Lower immunity.

20. Contd.
6. Migraine and tension typed headache
A severe recurring headache, usually affecting only one side of the head,
that is characterized by sharp, throbbing pain and is often accompanied by
nausea, vomiting, sensitivity to light and visual disturbances. Vasodilation
in the brain causes inflammation that results in pain, but the exact cause is
unknown.

21. Contd.
7. Pain disorders: A pain disorder is characterized by the presence of, and focus on,
pain in one or more body sites and is sufficiently severe to come to clinical attention.
- Patients experiencing bodily pain without identifiable and adequate physical causes
may be symbolically expressing and intra – psychic conflict through the body.
- Pain behaviors are reinforced when rewarded and are inhibited when ignored or
punished.
- Means for manipulating and gaining advantage in interpersonal relationships. Such
secondary gain is most important to patients with pain disorder.
- Serotonin and endorphins play a role in pain disorders.

22. Contd.
8. Malingering:
- Involves the intentional reporting of physical or psychological
symptoms in order to achieve personal gains.
- Common external motivations include avoiding the police, receiving
room and board, obtaining narcotics, and receiving monetary
compensation.
9. Factitious Disorder:
- Occurs when physical or psychological symptoms are intentionally
produced or feigned to gain attention.
- Sole purpose is to draw others’ attention because of their sickness.

24. Clinical features
• Specific sensations, such as pain or shortness of breath, or more
general symptoms, such as fatigue or weakness
• Unrelated to any medical cause that can be identified, or related to a
medical condition such as cancer or heart disease, but more significant
than what's usually expected
• A single symptom, multiple symptoms or varying symptoms
• Mild, moderate or severe

25. Contd.
• Constant worry about potential illness
• Viewing normal physical sensations as a sign of severe physical illness
• Fearing that symptoms are serious, even when there is no evidence
• Thinking that physical sensations are threatening or harmful
• Feeling that medical evaluation and treatment have not been adequate

26. Contd.
• Fearing that physical activity may cause damage to your body
• Repeatedly checking your body for abnormalities
• Frequent health care visits that don't relieve your concerns or that make
them worse
• Being unresponsive to medical treatment or unusually sensitive to
medication side effects
• Having a more severe impairment than is usually expected from a
medical condition

27. Treatment
• A major role of psychiatrists and other physicians working with
patients with psychosomatic disorders is mobilizing the patient to
change behavior in ways that optimize the process of healing.
• This may require a general change in lifestyle (e.g., taking vacations)
or a more specific behavioral change (e.g., giving up smoking).
Whether or not this occurs depends in large measure on the quality of
the relationship between doctor and patient.

28. Contd.
• Failure of the physician to establish good rapport accounts for much of
the ineffectiveness in getting patients to change.
• Ideally, both physician and patient collaborate and decide on a course
of action. At times this may resemble a negotiation in which doctor and
patient discuss various options and reach a compromise about an
agreed-on goal.

29. Contd.
• Direct education: Explain the problem, goals, and methods to achieve
goals. Every effort should be made to convey to belligerent patients
both understanding and tolerance for their feelings.

30. Contd.
• Third-party intervention: Family members, friends, and other
clinicians can provide support and encourage the patient to follow a
course of action

31. Contd.
• Exploration of options: There may be alternative methods for
achieving a desired goal. For example, quitting smoking can be done
with support groups, nicotine patches or gum, psychotropic drugs

32. Contd.
• Provision of sample treatment If a patient fears a particular course of
action or considers change impossible, a treatment trial can be
implemented. The patient always may opt out of the prescribed
program.
• Control sharing: Some patients resent any approach that appears to be
authoritarian. They may wish to set the pace of a withdrawal program
or titrate their medication depending on adverse effects.

33. Contd.
• Concession making: The clinician
may grant the patient something that he
or she wants as a bargaining chip to get
the patient to comply with advice.
• Empathic confrontation: Patients who
resist change may do so because of fear
or other uncomfortable emotions of
which they are unaware.

34. Contd.
Self Observation
Cognitive restructuring
Relaxation training
Time management
Problem Solving

35. Contd.
Relaxation Therapy
JPMR (Jacobson
Progressive
Muscle
Relaxation)
Benson
Relaxation
therapy
Hypnosis
Biofeedback

36. Contd.
• PROBLEM SOLVNIG : The final step is problem-solving in which
patients basically try to apply the best solution to the problem situation
and then review their progress with the therapist.

37. Nursing Management