Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Antecedents to Somatoform Disorders: A Pre- and Perinatal Psychology Hypothesis

Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Antecedents to Somatoform Disorders: A Pre- and Perinatal Psychology Hypothesis

Article excerpt

ABSTRACT: The somatofonn cluster of behavioral disorders is the single most frequent class of unexplainable problems found in primary care medical settings today. What is known about these disorders is that there are physiological, social, and psychological variables that need to be considered. What is not known is how a person develops a propensity toward having physical symptoms as their primary complaint. The author suggests that human beings are classically conditioned when faced with intolerable emotional experiences in the womb or during birth. The residual feelings are laid down in the developing brain's neural pathways in an adaptative strategy of escape and avoidance (focusing on the body instead of the feelings), allowing the organism to survive.

INTRODUCTION

Somatization has been defined the most simply and intelligibly as: The expression of psychological pain through physical symptoms (Fauman, 1994). Physical pain is defined here as an unpleasant sensory experience that is associated with actual tissue damage (Benoliel, 1995). The somatoform disorders, according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders; APA, 1994), are a cluster of symptoms and behaviors with common features, primarily persistent or recurring physical complaints that are not supported by actual physical findings (Kirmayer & Taillefer, 1997).

The somatoform cluster of behavioral disorders are the single most frequent class of problems in primary care medical settings (Mayou, Bass & Sharpe, 1995). Unexplained symptoms constitute from 25% to 60% of family medicine practices (Kirkwood, Clure, et al., 1982). These disorders cause clinically significant personal distress and/or impairments in social, occupational, or other areas of functioning (APA, 1994). Though the focus may be on bodily ailments, the research shows, there are also many more complex, underlying psychosocial and emotional antecedents, pain-related dysfunctions or disabilities, comorbid conditions, and pain-sustaining factors as well (Reid, Balis & Button, 1997).

PSYCHOSOCIAL ANTECEDENTS

The concept that psychosocial Stressors influence or exacerbate illness is certainly not new. Clinicians know that it is often possible to understand the complexity of present difficulties by examining the individual's life history. Many studies have noted that traumatic or stressful experiences seem to be qualitatively different from memories of ordinary events and are more emotional in nature (Teff, 1988; van der Kolk, 1994). Elevated life stress predicts a greater frequency of medical visits, strongest among patients with personality traits characterizing a tendency toward somatization (Miranda, Perez-Stable, Munoz, Hargreaves & Henke, 1991).

It is a very difficult task determining the underlying components when diagnosing and treating a somatoform disorder because of the multitude of psychological factors that may contribute to the development, maintenance, or exacerbation of a somatic or physical complaint. Adding to the confusion is uncertainty as to the antecedents of the psychological pain. There are divergent views from scientists on this issue of origination as well. Before looking more closely at the hypothesis offered as an explanation of the antecedents, found in the earliest period of human development, an examination of the expression of physical complaints, within a cultural context will be offered.

PAIN EXPRESSION AND CULTURE

Every culture determines what are the accepted "help-seeking" behaviors for emotional pain and human suffering. If physical complaints are more socially acceptable than psychological distress, as is true in the United States, then somatic complaints are expressed (Chaplin, 1997). Western culture allows symptom relief when received from a physician who can determine the source of the pain or complaint and prescribe the appropriate medication. The cultural norm for pain expression in the United States is that a person will be given sympathy and attention with a physical ailment but can expect rejection with a mental one. …

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