Psychophysiological disorder is also popularly known as psychosomatic disorder. The term psychosomatic was coined by Heinroth (1818). It was introduced with the study of the effect of emotion on the various body organs.
However, the American Psychiatric Association prefers the term psychophysiological while referring to specific disorders and psychosomatics for the general approach to medicine in which physical, psychological and socio-cultural factors are considered. In this article , we will use both the terms as more or less synonymous.
The term psychophysiological itself emphasises the fact that we are talking about disorders caused and maintained mainly by psychological and emotional factors rather than by organised causes. In psychophysiological dysfunction the psychological disorders or difficulties are expressed through some physiological pathology.
Experiments by Cannon and Bard in the early part of the 20th century on the effect of emotion on bodily changes stimulated large number of researches which brought about radical change in the discipline of psychophysiological medicine. Freud (1949) also believed that the pent up psychic energy does find its expression in physiological dysfunction.
According to Alexander (1950) each type of psychosomatic disorder may be connected with specific types of stress. He viewed for instance, Peptic ulcer associated with the frustration of love need and the need for protection. Frustration of these needs he explained caused anger and anxiety which stimulated secretion of acids in the stomach.
This leads to peptic ulcers. In Russia, based on pavlovian principles, studies on psychosomatic disorder were conducted. These studies were more objective and had an experimental basis.
To put it differently, in psychosomatic disorder, psychological life of an individual frequently influences his physical health. In fact the symptoms, the course and even the outcome of the physical disorders involve the interaction of physiological, psychological and social factors.
They are always accompanied by emotional reactions which bring about pathological changes. There are plenty of evidences to show that in different physiological diseases psychological factors play a major role. In the psychophysiological disorder there is a genuine physical disease which brings in physical dysfunction.
Psychological and physiological factors are so related that which one is more urgent, is difficult to say. For example, in anxiety, the psychological and physiological factors are embedded in such a way that it is difficult to segregate their influence.
DSM II defines the psychophysiological disorder as “characterized by physical symptoms that are caused by emotional factors and involve a single organ system usually under autonomic nervous system innervation.”
According to DSM IIIR the diagnostic criteria for psychosomatic disorder is psychologically meaningful environmental stimuli that are significantly and temporarily related to the initiation of a physical disorder. As an example, this may be a demonstrable organic pathology like rhematoid arthritis or a known physiological process like migraine headache.
The diagnostic criteria for psychological factors affecting physical condition as specified by DSM IIIR are:
1. Psychologically meaningful environmental stimuli are temporarily related to the initiation or exacerbation of a specific physical condition or disorder.
2. The physical condition involves either demonstrable organic pathology such as rheumatoid arthritis or a known physiological process like migraine headache.
Although very few psychosomatic disordered persons take admission in hospitals, yet due to their life threatening consequences, these disorders require special attention.
Psychologists have opined that if emotion or stress is the sole cause of psychosomatic disorder, then why different individuals choose different organ systems as sites for psychosomatic disorders instead of one particular organ? Three different guesses have been made by researchers as to why a particular psychosomatic disorder might be chosen.
Specific psychosomatic disorders occur in the organ system that is weakest. This weakness may have a genetic or environmental cause. For example, if the weakest organ in a person is his digestive system and he experiences continued emotional stress; he may suffer from peptic ulcer.
The second explanation suggests that there are differences in inherited patterns of response to stress that may predispose people to develop specific system breakdowns. For example, people who have dependence — independence conflict may be more prone to develop ulcers. Similarly, some people respond to stress situation with high blood pressure, whereas others may respond to the breakdown of the respiratory system in the form of asthma.
According to the third explanation neither weak organ systems nor inherited response patterns, but specific types of personality patterns are principal cause for the development of psychosomatic disorders.
In psychophysiological disorders, there are specific patterns of symptoms and the explanation and treatment for one type of psychosomatic disorder are usually not applicable to the other types.
The clinical picture of the psychosomatic disorders tends to be phasic i.e., there are periods of increase in the symptoms followed by a waning or disappearance of the symptoms. The sequence of their appearance or disappearance seems to be related to the amount of tension the individual is expressing. For example, an extremely busy business executive may find his ulcer being getting alright during a month’s vacation.
It is also interesting to note that there are marked differences between the sexes in the incidence of specific disorder. For instance, ulcers are much more common among men than in women. Similarly, rheumatoid arthritis is much more common among women than in men.
From this classification it is clear that psychophysiological disorders include a wide range of dysfunctions in which stresses and strains of life play a casual role.
Classification of psychophysiological disorders:
In the APA classification 10 types of psychophysiological disorders are listed by taking symptoms into account.
They are as follows:
1. Psychophysiological skin disorders — neurodermotosis, alopicder- matitis, eczema, and some cases of acne and hives.
2. Psychophysiological musculoskeletal disorders — back ache, muscle cramps, tension headaches, and some cases of arthritis.
3. Psychophysiological respiratory disorders — bronchial asthma, hyperventilation syndromes, hiccoughs and recurring bronchitis.
4. Psychophysiological cardiovascular disorder — hypertension, paroxysmal tachycardia, vascular spasms, heart attacks and migraine headaches.
5. Psychophysiological hemic and lymphatic disorders — disturbances in the blood and tymphanic systems.
6. Psychophysiological gastro intestinal disorders — Peptic ulcers, chronic gastritis and mucous colitis.
7. Psychophysiological genitourinary disorders — disturbances in menstruation and urination.
8. Psychophysiological endocrine disorders — hyper thyroidism, obesity and other endocrine disorders, emotional factors playing a causative role.
9. Psychophysiological disorders of organs of special sense — chronic conjunctivitis.
10. Psychophysiological disorders of other types — disturbances in the nervous system in which emotional factors play a crucial role — multiple sclerosis.
From this classification it is understood that a wide range of dysfunctions are included under psychophysiological disorders in which stresses and strains of life play a casual role.