Notes: Physical Problems, Psychological Sources (Lesson 22.1)

Role of Emotions in Health

  • Health is a concept that embodies the whole person

  • Animals have evolved a stress response mechanism that protects them during times of threat or illness

  • Fight-or-flight response

  • This section sets the stage for understanding how emotions and stress relate to physical health and illness

Anxiety and Stress (Slide 1 of 3)

  • Stressors of modern life are many, but outlets for the stress response are few

  • Physiological stress response (the body's automatic reaction to perceived threats)

  • Biochemical fight-or-flight system

  • General adaptation syndrome

  • Biochemical reactions of the stress response and their effects on various body systems

  • Connections to foundational principles: stress physiology underpins many psychosomatic and psychophysiological disorders

Anxiety and Stress (Slide 2 of 3)

  • Physical problems that arise from psychological sources create disorders such as:

    • Somatoform disorders

    • Psychosomatic disorders

    • Psychophysical disorders

  • The psychological aspects of an individual have a strong impact on the ability to identify and successfully cope with stress

  • The immune system is affected by stress levels

  • Practical implication: chronic psychological stress can dysregulate multiple body systems via neuroendocrine and autonomic pathways

Anxiety and Stress (Slide 3 of 3)

  • Childhood sources influence adult stress responses

  • Individuals learn how to perceive and respond to stress in childhood

  • Children who have experienced an unstable home environment may react to stress as adults with exaggerated hormonal mechanisms

  • Families who emotionally support and encourage their children to cope with stress have fewer physical complaints

  • Connection to development: early environments shape physiological stress reactivity and coping styles

Physical Conditions Affected by Psychobiological Factors (Slide 1 of 3)

  • Cardiovascular system issues associated with stress and emotions

  • Migraine headaches

  • Tension headaches

  • Hypertension (high blood pressure)

  • Angina (chest pain)

  • Musculoskeletal disorders

    • Rheumatoid arthritis

    • Low back pain

  • Respiratory conditions

    • Hyperventilation

    • Asthma

  • Implications: stress and emotions modulate pain perception, vascular tone, and inflammatory processes

Physical Conditions Affected by Psychobiological Factors (Slide 2 of 3)

  • Gastrointestinal disorders

    • Anorexia nervosa

    • Obesity

    • Peptic ulcer

    • Irritable bowel syndrome

    • Colitis

  • Skin disorders

    • Neurodermatitis

    • Eczema

    • Psoriasis; pruritus

  • Interplay: psychosocial factors can worsen GI and skin conditions via autonomic and immune pathways

Physical Conditions Affected by Psychobiological Factors (Slide 3 of 3)

  • Genitourinary issues

    • Impotence

    • Frigidity

    • Premenstrual syndrome

  • Endocrine conditions

    • Hyperthyroidism

    • Diabetes

  • Takeaway: psychobiological factors can influence hormonal balance and disease expression across organ systems

Common Psychophysiological Problems (Slide 1 of 2)

  • Stress-related physical problems

  • The body system that experiences much of the stress response is the gastrointestinal tract

  • Psychophysical disorder

  • Stress response theory

  • Individuals are biochemically patterned to react to stress

  • Carl Jung’s theory: symbolic meaning attached to a symptom or illness

  • Psychophysical theories

  • Note: these concepts link psychological processes with physical symptoms and disease risk

Common Psychophysiological Problems (Slide 2 of 2)

  • Psychophysical theories (continuation)

  • Erich Fromm’s theory

  • Certain personality types are prone to develop certain illnesses

  • Organic weakness theory

  • Every individual has one body system that is more sensitive than other systems

  • Implication: individual differences shape vulnerability and symptom patterns

Somatoform Disorders (Slide 1 of 3)

  • Somatization: feeling physical symptoms in the absence of disease or out of proportion to an ailment

  • Almost 80%80\% of basically healthy people have somatic symptoms in any given week

  • Signs and symptoms of illness may be the client’s way of coping with emotional distress

  • Emotional stress depletes the body’s energies, resulting in decreased immune function, which can make the person more susceptible to actual illness and disease

  • Key concept: somatic symptoms can be a psychosocial coping mechanism

Somatoform Disorders (Slide 2 of 3)

  • Cultural influences: many somatic illnesses are based on cultural or spiritual beliefs

  • Assessments and treatment plans must not threaten or challenge these beliefs if therapeutic interventions are to be effective

  • Effective health care providers learn as much as possible about other cultures to provide respectful care

Somatoform Disorders (Slide 3 of 3)

  • Criteria for diagnosis:

    • No organic medical condition that explains the symptoms can be found

    • The disorder significantly disrupts or impairs one’s level of functioning

    • The client is unaware of or is unable to express his or her emotional distress

  • Practical note: diagnosis relies on exclusion and psychosocial assessment

Somatic Symptom Disorder (Slide 1 of 2)

  • Historically referred to as Briquet’s syndrome or hysteria

  • Polysymptomatic disorder

  • Condition is associated with many signs and symptoms

  • Both genetic and environmental factors contribute to risk of developing a somatization disorder

  • Clients often seek treatment from several physicians simultaneously

  • Relevance: fragmentation of care can occur if emotional distress is not addressed

Somatic Symptom Disorder (Slide 2 of 2)

  • How to differentiate from a medical problem:

    • Involvement of multiple organ systems suggests a somatization disorder

    • Early onset and chronic condition with no lasting physical changes over time

    • Absence of significant laboratory values indicates underlying emotional basis

  • Diagnostic emphasis: patterns of symptoms across systems with psychosocial correlates

Conversion Disorders (Slide 1 of 2)

  • Conversion disorder: a somatoform disorder where the individual presents problems related to sensory or motor functions

  • Appears more commonly in:

    • Persons of lower socioeconomic status

    • Those living in rural areas

    • Individuals with little health care knowledge

  • Social and access factors influence presentation and continuation of symptoms

Conversion Disorders (Slide 2 of 2)

  • Thought to result from emotional (psychic) conflict

  • Signs and symptoms tend to be more in keeping with the individual’s ideas of what the problems should be

  • La belle indifference: lack of concern or indifference about signs or symptoms

  • Clinical note: emotional conflicts may be expressed through conversion symptoms rather than direct emotional expression

Illness Anxiety Disorder

  • Formerly known as hypochondriasis

  • A somatoform disorder with intense fear of or preoccupation with having a serious disease or medical condition based on misinterpretation of body signs and symptoms

  • Clients commonly “doctor shop”

  • Can begin at any age

  • Often difficult to treat

  • Practical implication: cognitive-behavioral strategies and reassurance balanced with medical evaluation may be used

Factitious Disorders and Malingering

  • Factitious disorders and malingering differ from somatoform disorders in that signs and symptoms are produced intentionally

  • Clients willfully produce signs or symptoms of illness for some form of gain

  • Factitious disorder by proxy (Munchausen’s syndrome) involves intentionally producing signs and symptoms in another person

  • Malingering: individual produces symptoms to meet a recognizable goal

  • Ethical concern: distinction between psychological needs and external incentives must be carefully assessed

Implications for Care Providers

  • Goals of care:

    • Rule out the presence of any physical disease or dysfunction

    • Develop a trusting caregiver-client relationship

    • Encourage the expression of feelings and emotional states rather than solely physical complaints

    • Meet physical needs when necessary, but encourage independence

  • Practical approach: integrated care that validates distress while addressing both medical and psychosocial needs

  • Cultural sensitivity and ethical consideration are essential for effective management

Questions?