Application to Syndromal Diagnosis

In the case of the somatoform disorders as syndromal diagnoses, these dimensional diagnostics would produce results as given in Box 3. The dimensions of the matrix are compared with the memory (B), avoidance (C) and arousal (D) criteria for PTSD in the DSM.

Key:

DSM criterion Matrix dimension

Trauma 1 Genetic floorplan

Memory 2 Acquired automated mechanisms

Avoidance and numbing 3 Declarative faculty

Arousal/hypervigilance 4 Complex, language dependent systems

Psychophysiology is a component of the biological dimension, which is common to all species across their phylogenic development. It is the physiology of adaptation that occurs in all normal individuals. Pathophysiology is defective functioning and is irreversible. Interpretation of a symptom can be an associative process. Conversion is avoidance associated with certain memories. Dissociation is also a process at the level of this dimension. It seems a logical assumption that different species, animals and man, could share it. This is different for the third level, the semantic or declarative dimension. Humans learn to declare their emotions and they learn from their own psychophysiological sensations, which become incorporated in associative programmes. Incomplete emotional declaration is known as lexithymia and is a basic phenomenon in somatoform and functional disorders. Breaking down syndromal diagnoses or classifications into their constituents allows recognition of the characteristic elements of psychological traumatisation.

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