Can we have 3 examples of definite psychosomatic disorders? (Remember what happened about Stomach Ulcers).

Dear Anthony, my primary research interest is in somatoform disoders (as boradly definded in the DSM IV, or F45.4 as defined in the ICD). I don't know whether they could/should be called "definite" psychsomatic or not (Fibromyaliga and CFS are good examples of such debate too). I am rather interested whether current research shows some repetitive interpersonal patterns in such patients.

I wonder if these articles will interest you:

• High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis
• Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome
• Assessing embodied interpersonal emotion regulation in somatic symptom disorders: a case study

https://academic.oup.com/humrep/article/17/10/2715/607769

Article Central sensitization: A biopsychosocial explanation for chr...

Article Assessing embodied interpersonal emotion regulation in somat...

Thank you very much, Stephen, indeed, both very interesting studies!

Search works from David Maldavsky, Sami Ali and David Lieberman

"I don't know whether they could/should be called "definite" psychosomatic or not"

In the absence of a single clear example of a psychogenic somatic disorder, I will stick with the simpler explanation that the psychological/psychiatric changes are secondary to unknown or unrecognised physiological disorders.

Basically, allergy in skin or respiration sistem, also úlceras adn irritable colon are psychogenic somatic disorders

Depends on what you mean by psychogenic. Yes, they have psychological aspects to their maintenance and perpetuation but we know that many of these have very definite biological triggers e.g. gut infections in irritable bowel syndrome. I'm also not sure why those specific ones are being labelled as psychosomatic and not others - almost all physical conditions have psychological components to them.

As ever when this topic is discussed hackles go up about the use of different terms. Typically the phrase ‘psychosomatic’ is understood to mean that conditions are generated psychologically without physiological basis but a unity of the words psyche and soma should mean just that – recognising the role of psyche in somatic symptoms and distress. Nahal is right to say that nearly all physical conditions have psychological components to them, but the use of phrases such as ‘psychosomatic’ tend to be reserved for conditions where psychological factors are discernible. In the UK, medical practitioners opt for alternative phrases such as ‘functional symptoms’ or ‘persistent physical symptoms’ in part to recognise that these are nonetheless real physical symptoms.

In many cases psychological factors are not merely secondary to physiological factors and the evidence base already exists. Conditions such as fibromyalgia and irritable bowels have been associated frequently with higher incidences of childhood adversity, highly stressful life events, and present stress and anxiety. Psychological stress stimulates release of hormones including cortisol, known to inhibit various aspects of immune activity. Hence we can often become susceptible to colds and bugs because we’ve got tired and run down. Depression can have tangible physical symptoms such as constipation, interruption in menstrual cycle, and loss of libido.

And in addition to observed physiological incidence of symptoms, our mental state can determine how we interpret physical sensations, and indeed how intensely we experience them. Psychological factors are often not just downstream consequences of physiological distress but implicit in the generation and experience of that distress. I know in my experience as a practitioner that my client’s somatic symptoms ‘flare up’ in certain scenarios that are stressful to them, and I know this personally as a sufferer of chronic pain.

The point being that conditions should be neither ringfenced as psychological or physiological but that all our life systems, including our central nervous system, are involved in the maintenance of health and disruptions to one system have influences over the others.

Dear John, thank you very much for your elaborate clarification, I would definitely agree with all the remarks and with your practical observations. Indeed, it feels to that the very term 'psychosomatic' causes considerable debate. I think also a lot of good studies from pervious decades are forgotten just because they use old terminology. Hopefully we will be heading towards a more systemic understaing in future.

In any case everyone can observe that psychosomatic specificity does exist. In my opinion her mecanism is still largely unknown. I think that from a psychoanaliyical point of view you can give a look to the Nancy Mc Dougall work and, recently, Lemma work. Some years ago I worked on biofeedback that I think is another good model ( in Italy Pancheri and Biondi) . Then there are the more recent studies on neuroendocrinology.

thank you very much Giovanni, I will take a look at these authors!