Friday, April 17, 2009

Psychosomatic Symptom: How and Why Are Our Patients Affected

OBJECTIVES:
Mammographers and, indeed, all medical personnel that deal with the possibility of serious illness are well acquainted with the cancer phobic, the anxiety ridden patient, and the patient with symptoms unrelated to physical cause.
Breast imaging is largely the province of the upper to middle class urban patient. We are living in very stressful economic times. These times are hardest on this sector of the population, a sector which has been, up to now, largely stress-free. With the onset of new and unfamiliar stresses, we will get an influx of anxiety produced symptoms. Stress is the body’s response to external conditions that alter a person’s equilibrium. Almost all the body’s organs participate in this reaction, including the brain, nervous system, heart, blood flow, hormonal level, digestion, and muscular function.
Understanding is our best defense against anxious patients manifesting all manner of unusual symptoms.

What Is A Psychosomatic Illness?

Today the term ‘psychosomatic’ is used to express the existing relationship between the body and the psyche. In general terminology, patients suffer somatization when they present one or more physical symptoms and after a medical exam, these symptoms cannot be explained by a medical illness. Even though a person may really be suffering from an illness, when such symptoms and their consequences are excessive when compared to what would be expected the patient would be considered psychosomatic.

Psychosomatic Disorders

Psychosomatic disorders come in many and varied stripes. They can manifest in all parts of the body and through all of the body’s systems. With each separate system the manifestation of somatization can, and will, be different. Some examples of the possible wide-ranging symptoms in several physiological systems are:
  • At the digestive system level: peptic ulcer, gastritis, colitis, constipation, hemorrhoids, and alterations to the gallbladder.
  • At the respiratory level: bronchial asthma, bronchitis, allergic rhinitis, and sinus inflammation.
  • At the cardiovascular level: hypertension, heart attack, and brain hemorrhages
  • At the urinary/genital level: menstrual disorders, sexual dysfunction, urinary discomfort, etc.
  • In the Endocrine system: goiter, diabetes, hyperthyroidism, and obesity.
  • On the skin: eczema, itches, hives, psoriasis, etc.
  • In the Locomotive system: lumbar pain, posture defects, rheumatoid arthritis.
How common is psychosomatic illness?
Of the discomforts we all feel daily, 70% are due to natural causes. Among these, we find those that are caused by our body’s own functions, when we digest, breath, or when we feel body temperature change. Even, the habits of an unhealthy lifestyle such as bad nutrition, bad sleeping habits, or doing little physical exercise can cause us physical discomfort. The environment also influences our body, with factors such as pollution, humidity, heat, etc. Only 5% of our discomforts are due to actual physical illnesses. Furthermore, only 10% of these are serious. Therefore, out of every 1000 discomforts suffered only 4 are really due to serious illnesses.

What are the most common psychosomatic illnesses?

  • Depression
  • Gastrointestinal disorders (irritable colon, ulcers, diarrhea, constipation, gastritis, indigestion, etc.)
  • Cardiac illness (hypertension, heart attacks, hypotension)
  • Skin ailments (psoriasis)
  • Panic attacks, anxiety disorders
  • Insomnia
  • Cancer (symptoms and phobias of all sorts)
  • Headaches
  • Sexual dysfunctions (impotency, menstrual disorders, etc.)
  • Senses (burning eyes, conjunctivitis, sensory disorders)
  • Skin (allergic eczemas, hives, acne, circulatory disorders of the skin)
  • Skeletal (back pain, cramps, rheumatoid pain, and certain cases or arthritis)
  • Respiratory system: asthma incidents, rhinitis, and bronchitis.
What psychological factors are responsible for psychosomatic symptoms?
  • When someone is continuously in a stressful situation and is not able to resolve it adequately (is in a permanent stressful state).
  • When one of these vital emotions is not expressed adequately: Sadness-Anger-Affection-Fear-Happiness
  • When there is no practice of healthy habits: Good nutrition, physical activity.
  • When deep personal relationships are not shared or established.
  • When there is no knowledge on how to relax or adequately eliminate daily tensions.
  • When the person believes that they are helpless (a victim of circumstances) and they believe little can be done to alleviate their stress.
What environmental factors that generate stress are responsible for psychosomatic symptoms?
  • Violence, physical or psychological: theft, rape.
  • Overcrowding: aggressiveness, protecting vital space.
  • Overpowering stimuli: social, familial or external
  • Joblessness: stressful economic situations, uselessness or marginalization
  • Noise: it has been determined that noise over 80 decibels can produce arterial tension, deafness, headaches, anxiety.
  • Natural Disasters
  • Large Urban congestion
  • Work: many stressful situations are generated in the labor environment: lack of motivation, labor instability, changes in supply and demand
How to ameliorate the somatic effects of stress?
  • Relaxation helps control stress. It is beneficial to practice an exercise discipline such as yoga or body control exercises, at least 10 minutes daily.
  • Good balanced nutrition, with variety that includes fruits and vegetables, cereals and whole rice helps nourish our bodies and reduces stress
  • A reduced amount of fat and sugar can lower our stress level.
  • Enough sleep on a regular basis at regular time periods eases stress levels
  • An established routine before going to bed improves sleep patterns and therefore stress level.
  • Avoid alcohol and tobacco (this does NOT help).
  • Daily aerobic exercise increases cardiac frequency, reduces anxiety and depression.
SUMMARY:
We can readily see that somatic induced symptoms are quite common. Many of our patients come to us stressed and troubled. If we understand the roots of these manifestations we can deal with them better.
Psychosomatic symptoms may have a root cause that is not medical but the diseases and symptoms can be very real. Treat ALL your patients with the tolerance, tact and empathy they deserve.

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