CHAPTER 8

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Disorders Featuring Somatic Symptoms

Psychological factors may contribute to somatic, or bodily, illnesses in a variety of ways. The physician who sees Jarell has some possibilities to sort out. Jarell could be faking his pain and dizziness to avoid taking some tough tests. Alternatively, he may be imagining his illness, that is, faking to himself. Or he could be overreacting to his pain and dizziness. Then again, his physical symptoms could be both real and significant, yet triggered by stress: whenever he feels extreme pressure, such as a person can feel before an important test, Jarell’s gastric juices may become more active and irritate his intestines, and his blood pressure may rise and cause him to become dizzy. Finally, he may be coming down with the flu. Even this “purely medical” problem, however, could be linked to psychological factors. Perhaps weeks of constant worry about the exams and presentation have weakened Jarell’s body so that he was not able to fight off the flu virus. Whatever the diagnosis, Jarell’s state of mind is affecting his body. The physician’s view of the role played by psychological factors will in turn affect the treatment Jarell receives.

You have observed throughout the book that psychological disorders frequently have physical causes. Abnormal neurotransmitter activity, for example, contributes to generalized anxiety disorder, panic disorder, and posttraumatic stress disorder. Is it surprising, then, that bodily illnesses may have psychological causes? Today’s clinicians recognize the wisdom of Socrates’ fourth century B.C.E. assertion: “You should not treat body without soul.”

The idea that psychological factors may contribute to somatic illnesses has ancient roots, yet it had few proponents before the twentieth century. It was particularly unpopular during the Renaissance, when medicine began to be a physical science and scientists became committed to the pursuit of objective “fact” (Conti, 2014). At that time, the mind was considered the territory of priests and philosophers, not of physicians and scientists. By the seventeenth century, French philosopher René Descartes went so far as to claim that the mind, or soul, is totally separate from the body—a position called mind-body dualism. Over the course of the twentieth century, however, numerous studies convinced medical and clinical researchers that psychological factors such as stress, worry, and perhaps even unconscious needs can contribute in major ways to bodily illness.

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DSM-5 lists a number of psychological disorders in which bodily symptoms or concerns are the primary features of the disorders. These include factitious disorder, in which patients intentionally produce or feign physical symptoms; conversion disorder, which is characterized by medically unexplained physical symptoms that affect voluntary motor or sensory functioning; somatic symptom disorder, in which people become disproportionately concerned, distressed, and disrupted by bodily symptoms; illness anxiety disorder, in which people who are anxious about their health become preoccupied with the notion that they are seriously ill despite the absence of bodily symptoms; and psychological factors affecting other medical conditions, disorders in which psychological factors adversely affect a person’s general medical condition.