What are the psychosomatic disorders of man

Psychiatry, Psychosomatics & Psychotherapy


Psychosomatics is understood to mean a way of looking at health and illness in medicine, which understands the human being as a unique mental-emotional-social-physical unit. In the presence of physical disorders, it emphasizes the consideration of mental-emotional and social factors for the understanding of disease development and healing (1) and assumes a biopsychosocial disease model (2) for the development and maintenance of diseases. Illness and health are therefore not viewed as two different states, but are in close dynamic interaction with one another. Psychosomatics is a medical-psychological theory of diseases that attaches essential importance to psychological processes and psychosocial influences in the development and healing of physical ailments and also makes physical factors jointly responsible for the development of mental disorders.

What are psychosomatic illnesses?

For many years, psychosomatic illnesses were understood to mean physical (somatic) illnesses and complaints that are caused, exacerbated or sustained by psychological and psychosocial stress. These illnesses were seen as an expression of an individual conflict-related or traumatic-situation-related experience processing, whereby the feelings that arise such as fears, anger or helplessness manifested themselves in physical states. According to Freud, it was even possible to infer the underlying psychological conflicts from the physical discomfort, as can be read in the theory of "conversion disorder". Accordingly, the shift in feelings to physical symptoms is to be understood as a defense mechanism that is supposed to improve the handling of difficult life situations. Today, however, this approach of psychosomatics is to be viewed critically: With the introduction of the biopsychosocial disease model, which is applied to both organic diseases and mental disorders, a separation into psychosomatic and purely psychological or somatic diseases is no longer tenable and a distinction between psychiatric and psychosomatic illness is ultimately not possible. It has been proven that the psyche has an influence both in the case of physical illnesses and, conversely, the state of the body also influences psychological disorders. A distinction is currently made between two approaches to psychosomatics:

  • a depth psychological perspective that builds on the assumptions of psychoanalysis and has a more understanding and interpretative approach and
  • an empirical-scientific perspective that largely corresponds to the concept of behavioral medicine (3).

According to the empirical-scientific perspective, health and illness are not two separable terms, but rather form a whole that is closely interrelated. Thus today psychosomatics is an expression of a bio-psychosocial perspective and is described by the associated disease model.

Consultation and liaison psychiatry (KL psychiatry)

Consultant and liaison psychiatry is the co-treatment of patients on general (non-psychiatric) wards of a hospital or hospital by a specialist in psychiatry and psychotherapy Cooperation within a team of different doctors, including a specialist in psychiatry and psychotherapy. The term “liaison” includes the meaning “relationship” or “building bridges”. In the field of KL psychiatry, the term is used when there are constant and formal contacts (participation in rounds, reports or special consultations) as well as more intensive informal contacts between the psychiatrists and the physicians who are physically active. The aim of the joint work and intensive exchange is the early recognition of possible psychological impairments and, as a result, the improvement of the treatment results and the efficiency. Extensive international studies show that around every third patient treated in somatic clinics also has a mental or psychiatric disorder of disease value in addition to a physical illness (4), which is recognized more frequently through the networking of the specialist areas. The main tasks of KL psychiatry are, in addition to the specialist diagnosis focused on the current condition, also the preparation of therapy recommendations for patients. The KL psychiatrist conducts psychiatric-psychotherapeutic discussions with the patient during therapy, advises treatment teams and supports them in organizing appropriate psychiatric-psychotherapeutic follow-up care for the patient. The most relevant areas of KL psychiatry are currently psycho-oncology, interdisciplinary pain treatment, and sleep and fertility medicine.

KL psychiatry deals on the one hand with physically ill patients who have had additional psychiatric / psychosocial problems and on the other hand with physically ill people who benefit from psychiatric-psychotherapeutic support. An example of this is a 45-year-old patient diagnosed with breast cancer who has to make a decision for or against an operation or a 60-year-old patient who has had a heart attack and who develops depressive symptoms or a panic disorder due to the limitations in his life again looking for a new task and a new meaning in his life.

History of Psychosomatics

Psychosomatics has existed as an independent department for less than 100 years. In retrospect, various phases of development can be described: Between 1920 and 1960, the focus was on the depth psychological question of the psychogenesis of physical illnesses5. From the 1950s onwards, psychosomatic medicine was able to establish itself more and more through the establishment of various counseling centers in Germany, and new ideas came up with regard to the interactions between body and psyche. In the 1960s, the American internist George L. Engel developed the bio-psycho-social model (4), which described the complex psychological and physical interactions of the individual in his or her social environment. Using the stress model developed in this context, it was possible to establish connections between the subjective meaning of stress and the stress reactions that manifest themselves physically and psychologically. The question of what protects the person from distress, the stress that causes illness, led to research projects in the field of stress resilience and the emergence of health (salutogenesis) (6), which deal with current questions about the health-promoting properties of people and the prevention of diseases.

Importance of psychosomatics in the current care situation

Since psychosomatic medicine was anchored in the doctor's license to practice medicine in 1970 and the introduction of the “doctor for psychotherapeutic medicine” in 1992, psychosomatic medicine has been an obligatory part of medical education and training in Germany. In 2003 the specialist was renamed “Specialist for Psychosomatic Medicine and Psychotherapy” and, according to the model training regulations of the German Medical Association, includes the “recognition, psychotherapeutic treatment, prevention and rehabilitation of illnesses and states of suffering, the causation of which is caused by psychosocial and psychosomatic factors, including the physical and emotional factors caused by them Interactions are significantly involved. ”(7) In addition to resident specialists, psychosomatic illnesses in Germany are mainly treated in acute psychosomatic hospitals and psychosomatic rehabilitation clinics. The offer within Germany currently comprises approx. 16,000 beds in rehabilitation clinics and approx. 7,000 beds in acute hospitals and the treatment follows a biopsychosocial disease model. Psychosomatic facilities mainly treat patients with depression, eating disorders, anxiety disorders, obsessive-compulsive disorder, somatoform disorders, post-traumatic disorders and personality disorders.

Behavioral medicine

Behavioral medicine is an interdisciplinary science that emerged in the 1970s and takes into account psychological, social and biological factors in the development of illness and health. The focus is on the inclusion of behavioral procedures in the treatment of somatic diseases. These behavioral procedures are based on the empirically investigated methods of behavior therapy and include, among other things:

  • the use of biofeedback methods to control pain or to influence blood pressure
  • the prevention of epileptic seizures by learning seizure control mechanisms
  • and the use of programs based on learning psychology to change lifestyle.

Other organic diseases that respond to behavioral medicine include gynecological diseases, cancer, tinnitus, diabetes mellitus, respiratory diseases or obesity. The goals of behavioral medicine are also diverse and range from improved drug compliance to reducing anxiety before an operation. Behavioral medicine thus represents the latest development in psychosomatics and, with its view, abolishes the division into psychosomatic vs. non-psychosomatic in favor of a synergy of health and illness (2).

Sources / literature

(1) Uexküll T. (2002) (Ed.) Psychosomatic Medicine. Urban Schwarzenberg, Munich
(2) Engel GL. (1977) The need for a new medical mode: A challenge for biomedicine. Science 196: 129-136
(3) Egger JW. (1999) Health Psychology: Health Behavior and Health Motivation. Psychological medicine 1999, 10, 1, 3-12
(4) Arolt V, Diefenbacher A. (Ed.) (2003) Psychiatry in clinical medicine: consultant psychiatry, psychosomatic medicine and psychotherapy. Steinkopf, Darmstadt.
(5) Freud S. (1973) The psychogenic visual disturbance in a psychoanalytic view. Ges. Werke, Vol. VIII, pp. 94-102. Fischer, Frankfurt
(6) Antonovsky A. (1987). Unraveling the mystery of health: How people manage stress and stay well. Jossey Bass, San Francisco.
(7) (Sample) further training regulations of the German Medical Association: www.bundesaerztekammer.de/downloads/20130628-MWBO_V6.pdf

Authors: Prof. Dr. Ulrich Voderholzer (DGPPN), Prien am Chiemsee and Prof. Dr. med. Stefan Büchi (SGPP), miles