Anxiety and Somatoform

Anxiety inferred

Anxiety disorders are usually considered to involve anxiety and stress reactions which are vividly experienced by people who suffer from such conditions, and they are often observable. However, in certain other conditions, the underlying anxiety is largely inferred or assumed to be only present rather than being expressed outward.

For example, in somatoform and dissociative disorders, the person affected may not consciously feel anxious because the function of the disorders is to protect the person involved from strong psychological conflict. According to the beliefs of psychodynamic theorists, whatever may be the distress experienced by the person in such disorders, it is less stressful than the underlying anxiety it is being defended against itself.

Somatoform Disorders

Somatoform disorders involve physical complaints or disabilities suggestive of a medical condition but not present with a biological cause and are not voluntarily produced by the patient. People with hypochondriasis become unduly alarmed about any given physical symptom they feel is convincing them of being seriously ill or about to be. People who suffer from pain disorders experience intense pain that is either out of proportion to whatever medical condition they presume to have for which physical basis is unfounded.

Somatoform disorders differ from psychological disorders in which psychological factors cause or contribute to actual medical conditions such as asthma, migraine headaches, hypertension (chronic high blood pressure), cardiac problems, and peptic ulcers. For example, in a person with a peptic ulcer, stress can produce an outpour of peptic acid, causing an actual lesion in the stomach wall resulting in pain, which is caused by actual physical damage. In somatoform disorders, however, no physical basis for pain can be found.

Conversion Disorder

Conversion disorder may be the most fascinating somatoform disorder, in which serious neurological symptoms such as paralysis, blindness, or loss of sensation suddenly occur. Electrophysiological recordings and brain-imaging of such patients indicates that sensory and motor pathways in the brain are intact. People with conversion disorder often exhibit la belle indifference, which is a strange lack of concern of one's symptoms and its implications.

In some cases, the complaint by the patient themselves is psychologically impossible. An example of this is glove anaesthesia, in which a person loses all sensations below the wrist. The hand is served by nerves, which also provide sensory input to the arm and wrist, making glove anaesthesia anatomically impossible.

Trauma-induced Blindness

Even though psychogenic blindness is rare in the general population, researchers have discovered the largest-known civilian group of people in the world with trauma-induced blindness. These people were refugees who had escaped from Cambodia and had later settled in California. They are survivors of the killing fields of Cambodia who were subjected to unspeakable horror at the hands of the Khmer Rouge in the years that followed the Vietnam War.

More than a 150 of these people were functionally blind, even though their eyes appeared intact and electrophysiological monitoring showed stimuli registered to their visual cortex. Many of them reported that the blindness came on suddenly after they witnessed traumatic scenes of murder, meaning this was a psychological manifestation to past trauma.

Underlying Conflict

According to Freud, conversion symptoms are a symbolic expression of an underlying conflict which aroused a tremendous amount of anxiety, causing the ego to keep the conflict in the unconscious, thereby converting the anxiety into a physical symptom. For example, in one of Freud's cases, a young woman who was forced to care for her hostile, verbally abusive, and unappreciative father, had suddenly developed paralysis in her arm. According to Freud, this had occurred when her repressed hostile impulses threatened to break through and caused her to strike her father with that arm.

A combination of psychological and biological vulnerabilities may cause a person to have a predisposition to somatoform disorders. Somatoform disorders tend to run in families, but it isn't clear whether it's a reflection of the role of genetic factors, environmental learning, and social reinforcement for bodily symptoms or both.

Cultural Influence

In addition, some may experience internal sensations more vividly than others, or they may focus more attention on those symptoms. Patients with somatoform disorders are also very suggestible. In one study, somatoform patients were found more responsive to hypnotic suggestions than matched controls. Furthermore, the hypnotic susceptibility scores of conversion patients significantly correlated with the number of conversion symptoms reported by them.

Somatoform disorders have a higher prevalence in cultures that discourage open discussions on emotions or stigmatise psychological disorders. In Western culture subgroups such as the police or the military, discussing feelings and self-disclosing of psychological problems are frowned upon.

In such situations, somatic symptoms may begin to appear as the only acceptable outlet for feelings of emotional distress in such persons. The same may occur in people who are subjected to severe emotional constrictions, making them unable to acknowledge their emotions or verbally communicate them to others.