“Mental tensions, frustrations, insecurity, aimlessness are among the most damaging stressors, and psychosomatic studies have shown how often they cause migraine headache, peptic ulcers, heart attacks, hypertension, mental disease, suicide, or just hopeless unhappiness.” (Hans Selye)
Every day our body speaks a very particular language. Thus, listening to and understanding it is extremely important to prevent the onset of pathologies that threaten our health. These pathologies might affect our bones, skin, intestine, metabolism, and immune system. Understanding how to interpret this language, made of unique codes, can improve our daily life, well-being, and overall mental and physical functioning.
But how can we learn this language?
In this article, I discuss psychosomatic medicine, a comprehensive and interdisciplinary approach to assessing psychological factors leading to diseases and distress, and in which also biopsychosocial variables around patient care are evaluated to prevent and establish treatments. Besides, a closer focus on lifestyle, patient engagement, and psychosocial needs is also considered by psychosomatic medicine as a scientifically rigorous, diversified, and therapeutically relevant branch of medicine [1].
What is a psychosomatic disorder?
Psychosomatic disorder is a psychological condition that leads to physical symptoms, and this may happen even without a specific medical explanation. Because different parts of the body may be affected and often no clear diagnosis can be made, patients get frustrated, anxious, and worried. In fact, despite a lack of medical explanation and diagnosis, psychosomatic disorders lead to real and distressing symptoms which need attention and clear understanding. Behavioral therapies, lifestyle, and daily habits modifications can make a difference in a patient’s life, and also in preventing unnecessary treatments and tests. Thus, healthcare providers should be enough competent and experts to evaluate and assess every single case with proper care and empathy.
Somatic symptom disorder is very common typically observed between 5-7% of the population, and mostly affecting women than men. However, despite this rate, individuals who experience symptoms tend to don’t report their psychological distress. Rather, they believe that this is related to medical conditions, therefore they consult different healthcare professionals to receive a diagnosis and adequate treatments, but without any success, which in turn generates stress and worries. Furthermore, somatic symptoms can manifest at any age across the life cycle, particularly in those individuals who might have a chaotic life, resistance to express and recognize emotions, problems during childhood, the experience of sexual abuse, comorbidity with depression or/and personality disorders, use of drugs and other toxic-related substances, and condition of unemployment. These situations are responsible for generating psychosomatic disorders which affect different body parts causing fatigue, insomnia, aches, pain (e.g., muscle, back), high blood pressure, dyspnea (or any other breathing problems), indigestion, headaches (and migraine), any sexual dysfunction, skin rash (and type of dermatitis), stomach ulcers.
Psychosomatic medicine: an approach in psychiatry
Psychosomatic medicine (PM) is a new branch of medicine in the field of psychiatry and is also known as consultation-liaison (C-L) psychiatry in which psychiatrists and other specialized physicians collaborate together to treat and manage patients affected by a psychosomatic illness. Thus, it aims to investigate and gather insight concerning mental and physical illnesses by providing services and support such as diagnostic, therapies, and research.
Although this is a more recent approach to modern medicine, it has a long history. Indeed, the ancient Greeks and the French were already aware of psychosomatic disorders and Hippocrates advanced the “body-mind dualism” theory which inspired several research studies regarding the interconnection between the body and the mind.
By providing consultancy and primary care interventions, the psychosomatic medicine service (PMS) provides a comprehensive approach to supporting patients’ needs at the emotional, cognitive, and behavioral levels. Hence, the main goals of C-L psychiatry are:
● Medical expertise: C-L psychiatrists should have interdisciplinary expertise regarding physical, social, and neurological disorders and implement this knowledge in patient care (e.g., through interventions and treatments).
● Patient care: the quality of care involves in- and outpatients. Thus, it aims to provide the most suitable environment to support patients providing physical and mental health.
● Assessment of mental factors: based on consultancy, psychological and social components are also evaluated due to their relation to psychosomatic illnesses. Thus, the patient undergoes a complete assessment to estimate those factors potentially responsible for the mental illness which in turn affects also the body’s functioning.
● Personalized therapies: following a proper diagnosis, C-L psychiatrists are in charge to plan and develop a personalized intervention focused on preventive, treating, and recovery measures in response to physical diseases.
● Collaborative caring plans: a comprehensive and interdisciplinary approach is fostered to educate the patients, caregivers, and other health professionals on mental health and psychosocial aspects that may be at the origin of the patient’s disease. Thus, a target intervention can be planned.
● Training for health professionals: training programs are available to educate and prepare junior consultants, and (nonpsychiatric) healthcare providers in understanding and identifying adverse reactions that the patient shows to treatment, and besides this would include also the proper support through psychological care.
Therefore, psychosomatic medicine serves the patients by fulfilling several functions such as:
Clinical: at these levels, two types of psychiatrists are identified who have different responsibilities. Consultation psychiatrists typically work in outpatient departments and in chronic care facilities. Their major responsibility is to advise physicians in charge of planning and identifying the proper intervention. Differently, referral psychiatrists assist and support the physician by delivering to inpatients the proper psychiatric care.
Educational: experts in psychosomatic medicine are responsible for providing further educational programs to nonpsychiatric physicians, students, and other healthcare professionals (e.g., nurses and other medical staff). The major focus is on the understanding of the patients and his/her psychological needs (e.g., based on an attentive behavioral observation), management of operations concerning the treatment of the psychiatric condition, and the selection and administration of specific medicaments to patients.
Research: being PM is a novel branch of medicine, it requires constant research and experimentation to consolidate findings and enhance the interface between medicine and psychiatry. In addition, a strong focus on this interplay would give rise to new specialties such as psycho-oncology, psycho-immunology, and psycho-obstetrics. Consequently, research and application directly affect the quality of patient management, services, and delivery of care.
Administrative: this function refers to those conditions in which a patient is not compliant with following a given medical procedure or treatment. In this case, the psychiatrist is responsible for taking action for the patient’s safety and care (e.g., the patient has a violent behavior or suicidal behavior). This action is usually authorized, by the government or the institute of reference.
Others: PM also involves other types of services such as emergency interventions (e.g., suicidal behavior, violent actions), consultancy for patients who undergo surgery, and consultancy for those patients with specific medical conditions (e.g., AIDS, cancer, tumors, patients who are waiting for a transplant of organs, etc.), and also preventive measures in collaboration with other specialized healthcare professionals.
Diagnosis, treatment, and management
Despite psychosomatic symptoms manifesting clearly in the body, what causes these symptoms is not understood yet. Scientists and physicians suggest that specific “fight or flight” hormones and chemicals are produced in the body in response to stress and that are the cause of physical and mental dysfunction. In addition to physical symptoms (e.g., pain), the distress caused by a psychosomatic disorder affects also the personal and social aspects of life due to irritability, anger, depression, anxiety, difficult moments at work, with relatives and friends, and the dissatisfaction regarding the service provided by healthcare professionals. A typical diagnosis is based on examining the medical history, physical exam, and additional medical tests (e.g., imaging and blood tests) to exclude the presence of other pathologies. Therefore, to diagnose a psychosomatic disorder patients should have one or more symptoms that cause distress, symptoms should be observed for the last six months (at least), anxiety, and worries should also be associated with these overt symptoms. Accordingly, symptoms that cause psychosomatic disturbance are treated and managed through different types of interventions such as cognitive-behavioral-based therapy, mindfulness, target medications (e.g., antidepressants to treat depression), and psychiatric or psychological therapies.
Furthermore, besides the treatment of psychosomatic pain, the management of stress is another focus of psychosomatic medicine to prevent the worsening of conditions. A few strategies can be the establishment of a healthier lifestyle and habits (e.g., management of diet, weight, sleep, physical exercise), meditation, reduction of bad habits (e.g., smoking, alcohol), asking for help and support from beloved ones, and releasing the anxiety of controlling what is external and can’t be controlled. Thus, the awareness that a condition is causing mental distress and pain is the first step to reacting and preventing further impairments by contacting health professionals while seeking medical care and support.
To explore more about psychosomatic disorders and symptoms, read here.
Germany: an integrative “bio-psycho-social” approach in medicine
Psychosomatic medicine has greatly developed over the past decades, merging this discipline with internal medicine and introducing psychotherapy and psychiatric approaches. Besides, these advances have been supported by the rapid and progressive changes occurring in the entire healthcare organization. Thus, based on a consistent historical background in which different models explained the involvement of the mind, body, and social environment as separated systems [2], Germany proposed a novel model of Psychosomatic Medicine based on the conceptualization and integration of psychotherapeutic methods into clinical practice and while combining bio-psycho-social medicine into one interventional approach [3,4].
Indeed, the rapid development of psychosomatic medicine in Germany was mostly determined by the increasing number of patients and the need for effective interventions. Epidemiological studies have shown that 18.6% to 27.7% of the German population are affected by psychosomatic, psychiatric, or psychological symptoms. Thus, proper treatments and care are necessary [3,5,6]. Most frequently, 50% of these patients suffer from gastrointestinal and this disturbance is also accompanied by psychic symptoms. Moreover, 30-40% of inpatients show psychosomatic or psychological symptoms that need proper care and target intervention [7]. Besides, also outpatients manifest psychosomatic symptoms. Hence, a well-trained interdisciplinary team of healthcare professionals (e.g., nurses, general physicians, psychologists, psychiatrists) is highly needed to provide a comprehensive and personalized care approach. Unlike other countries, in Germany, psychosomatic medicine is not a subfield of psychiatry, although it shares a few approaches. In addition, also the spectrum of patients differs and in which psychotherapies are preferred compared to treatments based on psychopharmaceutical medicaments. Moreover, psychosomatic care in Germany has fostered an integrative approach one which functional disorders, eating disorders, and some somato-psychic disorders (e.g., concerning psycho-oncology, psycho-cardiology, pain, psycho-diabetology), but also other specialties typical of psychiatry (e.g., depression, anxiety, personality disorder) are interfacing with each other for comprehensive care [3].
A total of 223 institutions, covering more than 10,000 inpatients beds are prepared for psychosomatic consultation and liaison service. Hence, Germany is well-prepared to provide proper patients care, teaching, and research varying from academic institutions (e.g., departments of psychosomatic medicine and psychotherapy), to hospitals at the regional level that are primarily specialized in psychosomatic medicine or as part of psychiatric hospitals.
Due to the emerging need for better patient care, psychosomatic medicine in Germany became a comprehensive and integrative branch of medicine and a specialized field of study [2,3,8] and representing one of the largest institutions and not related to consultation liaison psychiatry [9]. Thus, the importance of stimulating further development, international exchange, and educational programs for training future healthcare professionals (e.g., in clinical and research environments) is necessary to further evolve this innovative field of medicine in which a multi-modal and interdisciplinary approach (e.g., psychodynamic, cognitive-behavioral interventions, physiotherapy, creative therapies) are combined into a framework to support patients and caregivers in their journey toward health [3, 10].
To learn more about psychosomatic medicine in Germany and its history, read here.
References:
Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010 Jul;64(8):1155-61. doi: 10.1111/j.1742-1241.2009.02266.x. PMID: 20642714.
Herzog W, Beutel M, Kruse J. Psychosomatische Medizin und Psychotherapie heute - zur Lage des Fachgebietes in Deutschland. Stuttgart: Schattauer; 2014.
Deter, HC., Kruse, J. & Zipfel, S. History, aims and present structure of psychosomatic medicine in Germany. BioPsychoSocial Med 12, 1 (2018). https://doi.org/10.1186/s13030-017-0120-x
Deter HC. Psychosomatic medicine and psychotherapy: on the historical development of a special field in Germany. Adv Psychosom Med. 2004;26:181–9.
Jacobi F, Höfler M, Siegert J, Mack S, Gerschler A, Scholl L, Busch MA, Hapke U, Maske U, Seiffert I, Gaebel W, Maier W, Wagner M, Zielasek J, Wittchen HU. Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the mental health module of the German health interview and examination survey for adults (DEGS1-MH). Int J Methods Psychiatr Res. 2014;23(3):304–19. https://doi.org/10.1002/mpr.1439. Epub 2014 Apr 11
Franz M, Lieberz K, Schmitz N, Schepank H. A decade of spontaneous long-term course of psychogenic impairment in a community population sample. Soc Psychiatry Psychiatr Epidemiol. 1999;34(12):651–6.
Deter HC. The integration of psychosomatics into clinical medicine. In: Seva A, editor. The handbook of psychiatry and mental health. Barcelona: Anthropos; 1991.
Fava GA, Belaise C, Sonino N. Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry. Curr Psychiatry Rep. 2010;12:215–21.
Malt UF. German psychosomatic medicine: an international perspective. Adv Psychosom Med. 2004;26:196–202.
von Uexküll T. Integrierte Medizin als Gesamtkonzept der Heilkunde: Ein bio-psycho-soziales Modell. In: Adler R, Joraschky P, Köhle K, Langewitz W, Söllner W, Wesiak W, editors. Psychosomatische Medizin: Theoretische Modelle und klinische Praxis, vol. 7. München: Elsevier; 2011. p. 3–40.
Photo by Mor Shani and Yoann Boyer on Unsplash
Comentários