Post-Traumatic Stress Disorder

The Spectrum of Post-Traumatic Syndromes

The Basic Stress Responses: Defence and Inhibition

Somatic Stress Syndromes

The Generation of Somatic Symptoms

Diagnostic Integration

Syndromal Diagnosis

Predictors and Risk Factors

Lifetime Development

Comorbidity

Overcoming Anxiety (Home) > Post-Traumatic Stress Disorder > The Generation of Somatic Symptoms

Generation of Somatic Symptoms: Depression and Anxiety

The three core groups of symptoms of post-traumatic syndromes are functions of memory, of avoidance and of alarm with its behavioural and physiological signs. With respect to the physical complaints, it is important to realise how physical signs and symptoms can be generated, see Box 1.

The Generation of Physical Signs and Symptoms

1. Biological source
   • Psychophysiological
   • Pathophysiological
2. Amplification Positive
   • Normal (psychophysiological) responses
   • Mild pathophysiological symptoms
     Negative: denial of major pathophysiological signs
3. Voluntary control
   • Adaptation to irreparable defect
   • Autonomic nervous system reactions
   • Conversion (sensory/motoric) Simulation (fantasy)
   •  Malingering (illegal gain)

A biological substrate is the rule. Amplification and voluntary control determine the presentation. As we have seen above, this is especially important in the somatoform disorders. The biological substrate may be either psychophysiological or pathological but its occurrence does not bring the patient to the doctor by itself. Epidemiological surveys have clearly demonstrated that this is a result of psychological variables.

Amplification can be negative which is named dissimulation. It can make patients with serious pathology postpone seeing a doctor for unreasonably long times. It is a phenomenon that can also be observed in patients with post-traumatic syndromes. It may seem paradoxical in comparison to the frequent medical consultations of many of such patients but it can be understood when considering a number of circumstances.

Firstly, workaholism is a defence strategy, which is employed by many traumatised people with considerable success over periods of decades. Breakdown of this psychological defence can occur due to a serious disease. Secondly, alexithymia, which is so common among traumatised persons not only implies inability to ‘‘read’’, that is to verbalise one’s emotions from the psychophysiological reactions of the body. It implies a more general inefficiency in judging the signals of the body, also in pathology.

Then, voluntary control over physical symptoms can help a patient to live with an irreparable defect like asthma or either with symptoms of a pounding heart, a dry mouth, trembling and sweating, etc. in cases of stage fright or even panic . Voluntary control also plays a role in the therapy of conversion disorder with respect to a patient’s regaining responsibility for his symptoms. Finally, cases of simulation and malingering can also be headed under voluntary control but in a different way.

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