Onset Conditions for Psychosomatic Symptoms: A Comparative Review of Immediate Observation with Retrospective Research

Abstract

A systematic review of 53 studies of the onset conditions revealed: (1) No symptoms were reported which were without psychological antecedents, although the level of the relationship between psychological antecedent and symptom was usually only moderate or weak; (2) the psychological antecedents, in order of rank with highest first, were resentment, frustration, depression, anxiety, and helplessness; (3) the special uniqueness of the review is in its systematic coverage of the "immediate-context" research (23 studies) and the comparison of those with a sample of "broad-context," mainly retrospective, research studies (30 studies). The same main types of psychological antecedents were reported by both types of studies with frequencies which were not significantly different except for frustration and separation. Frustration was more often reported in the immediate observation studies, separation more often in the broad-context studies. The review ends with suggestions of methods for understanding the mediation of psychological antecedents and symptoms. in a formal way, most family physicians and most patients could see at times a relationship between stressful experiences and the onset of certain somatic conditions. Much of the awareness of the relationship was lost to the medical profession around the turn of the century, when it became "scientific," but the topic was pursued in the research on psychosomatic medicine. The psychosomatic studies we have reviewed begin about 35 years ago in an era of uncontrolled observational methods. Studies of this kind have become increasingly sophisticated in research design. As we suggest later, not only were the early scientifically unsophisticated observations in accord with folk-belief, but also the more sophisticated research tended to confirm those earlier studies.Formal research on the onset of psy-

A Context Study of Psychological Conditions Prior to Shifts in Blood Pressure

“…data). The shifts after the thematic categories may be similar to the helplessness-hopelessness ante cedent state which has been reported for a variety of symptoms (6). On a neurophysiological level our findings can be interpreted in terms of arousal of die reticular activating system (RAS), which is responsible for the regulation of wakefulness and attention, and is closely interconnected with the cerebral cortex, with the striated muscles, and with the sympathetic nervous system via the adrenals and adrenalin.…”

“…The Symptom Context Method (SCM) assesses interview sequences anteceding the emergence of a symptom and compares them with symptom-free periods (6). This is the first study using the SCM for the analysis of psycho logical states before blood pressure (BP) changes.…”

Defense Mechanisms and Coping Behavior in Terminal Illness

“…Especially in psychosomatic studies it has always been possible to establish a correlation between the degree of success in the functioning of defenses and somatic processes (10,16,(25)(26)(27). The term 'coping behavior' combines uncon scious defense processes with attempts to adapt which are closer to the con scious level.…”

Psychogenesis of Somatic Disorders

“…In the same sense Engel (1967b) qualifies as 'helplessnesshopelessness' and 'giving up-given up' certain reactions to bereavement and real or symbolic object loss. Luborsky et al (1973) performed a systematic review o f 53 studies on the onset conditions for psychosomatic symptoms. The psychological antecedents, in order o f rank with highest first, were hostility, rejection, hopelessness, anxiety, and helplessness.…”