Chapter 8 – Summary
Psychophysiological disorders, formerly known as psychosomatic disorders, are physical diseases produced in part by psychological factors, such as stress. Such disorders usually affect organs innervated by the autonomic nervous system, such as those of the respiratory, cardiovascular, gastrointestinal, and endocrine systems.
Psychophysiological disorders no longer appear as a diagnostic category in the DSM. Instead, the diagnostician can make a diagnosis of psychological factors affecting a medical condition and then note the condition on Axis III. This change reflects the growing realization that life stress is relevant to all diseases and is not limited to those that were previously considered psychosomatic.
In attempting to understand the complex stress-illness relationship, researchers have focused on precisely defining what stress is, on measuring stress using such instruments as the Social Readjustment Rating Scale and Assessment of Daily Experience, on assessing differences in how people cope with perceived stress, and on moderators of the stress-illness relationship, such as social support.
Theories of the etiology of psychophysiological disorders are diathesis-stress in nature but differ in whether the diathesis is described in psychological or biological terms. Biological theories attribute particular disorders to specific organ weakness, to overactivity of particular organ systems in responding to stress, to the effects of exposure to stress hormones, or to changes in the immune system that are caused by stress. Psychological theories focus more on such factors such as unconscious emotional states, personality traits, cognitive appraisals, and specific styles of coping with stress.
Cardiovascular disorders, which involve the heart and circulatory system, include essential hypertension and coronary heart disease (CHD). While both conditions are complex and multifaceted, their etiologies appear to include a tendency to respond to stress with increases in blood pressure or heart rate.
Individuals with asthma tend to have a respiratory system that overresponds to an allergen or has been weakened by prior infection. However, psychological factors such as anxiety, anger, depression, and anticipated excitement may, through inducing emotionality, bring on an asthmatic attack.
Acquired immunodefiency syndrome (AIDS) has emerged since its identification in 1981 as the most serious infectious epidemic of modern times. AIDS has psychological elements in that it usually arises from behavior that appears irrational and generally is preventable by psychological means. The primary focus of prevention is to change people’s behavior, specifically, to encourage safer sex and to discourage the sharing of needles in intravenous substance abuse.
Because psychophysiological disorders represent true physical dysfunctions, treatment usually includes medication. The general aim of psychotherapies for these disorders is to reduce anxiety, depression, or anger.
Researchers in the field of behavioral medicine try to find psychological interventions that can improve the patient's physiological state by changing unhealthy behaviors and reducing stress. They have developed ways of helping people relax, smoke less, eat fewer fatty foods, and engage in behaviors that can prevent or alleviate illnesses, such as encouraging breast self-examination and adhering to medical treatment recommendations.
The emergent field of stress management teaches people without diagnosable problems techniques that allow them to cope with the inevitable stress of everyday life and thereby ameliorate the toll that stress can take on the body.