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Post-Traumatic Stress Disorder |
Overcoming Anxiety (Home) > Post-Traumatic Stress Disorder > Somatic Stress Syndromes Somatic Stress Syndromes: Post Traumatic and RelocationWhen considering the psychophysiology of the defence reaction, the symptoms of many functional syndromes can be understood as forms of recurrent or persistent alarm. Examples known in the literature are hyperventilation, hyperdynamic betaadrenergic circulation, adrenal exhaustion, hyperkinetic heart syndrome, circulatory neurasthenia, effort syndrome, autonomic dysfunction syndrome, neurasthenia, epidemic neuromyasthenia, benign myalgic encephalomyelitis, irritable bowel syndrome, chronic pelvic pain (CPP), ‘‘allergic to everything’’, sugar intolerance, reactive hypoglycaemia. More modern connotations are fibromyalgia, post-viral fatigue, chronic fatigue (and immune deficiency) syndrome (CFS/CFIDS), yuppie flu, etc. These functional syndromes basically consist of the psychophysiological arousal symptoms of the defence reaction. In none of these, a pathological basis, i.e. a histological or physiological defect, has been found. In addition, on close examination, these so-called syndromes show considerable overlap. I have noted already that somatoform disorders can be considered as post-traumatic syndromes and this has been substantiated by some evidence for somatisation disorder and hypochondriasis . It is even more evident as one notices that the basis of the physical complaints of these patients is actually largely made up by the psychophysiology of the defence reaction. The patient’s interpretation and illness behaviour make it hypochondriasis. Also in somatisation disorder, the basis of the physical complaints is in the psychophysiology of alarm (defence) and may be combined with conversion symptoms. The behavioural presentation is different from hypochondriasis; there may be more variation over time and very often patients are subject to multiple interventions, which may cause new problems of a pathological kind. Sexual or physical abuse in early life is the typical history of such patients. About a century ago, the French psychologist Pierre Janet has laid the basis for our understanding of conversion disorder as a post-traumatic syndrome . One of his famous examples was a case of behavioural repetition, a reenactment of a traumatic memory. Conversion in its present usual meaning can be well understood as a sensory or motoric avoidance symptom, upon which relational behaviour becomes superimposed. Finally, among the somatoform disorders we have pain disorder associated with psychological factors or with both these and a general medical condition (DSM-IV), which is one of the most difficult problems in health care. In my personal experience, psychophysiological or pathological causes of pain can usually be found in a patient with chronic pain but it can take much time and effort to discover either of these, or both. The patient’s behaviour can be an important reason for this and it reflects the description in the DSM-IV (APA, 1994), which points out that psychological factors are associated with the pain disorder. It may be a matter of interpretation whether a psychophysiological substrate, e.g. oesophageal or intestinal muscle contractions or stretching, voluntary muscle hypertonia etc., is such a psychological factor. In such cases a physical substrate, with activation of peripheral pain receptors and circuitry, is undoubtedly present and this coincides with the patient’s own perceptions. In fact, I have never met a case where pain or dysaesthesia could only and with certainty be understood as a memory, which is the implication and consequence of the absence of any substrate outside the central nervous system.
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