Nervous - got an exacerbation: what diseases can provoke stress
Miscellaneous / / April 05, 2023
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The publishing house "Alpina Publisher" published the book "Truth and Myths about Psychosomatics". Its author, psychologist and specialist in psychosomatic disorders, Natalya Fomicheva, talks about the relationship between the body and the mind and debunks the myths that surround the psychosomatic medicine. We publish an excerpt from Chapter 9 on the relationship between stress and disease.
So we got to those situations when the somatic begins to give way to the psyche the role of the protagonist. Or rather, not quite yet. Chapter 7 discussed how mental illness makes chronic illnesses worse. With psychosomatosis, the situation is different: the patient may be mentally healthy, but stress - and not only chronic, but also acute - causes an exacerbation of the somatic disease. Where it is thin, it breaks there.
In the 1930s, psychoanalyst Franz Alexander of the Psychoanalytic Institute of Chicago suggested that that in the occurrence of some somatic diseases an important role is played by psychological component.
The author listed seven such diseases and called them the “Chicago seven psychosomatosis”, suggesting that doctors team up with a psychotherapist in their treatment. Since then, evidence-based medicine has been fruitfully engaged in research: what is the role of the psychological component in the occurrence and course of these diseases? Franz Alexander's ideas have been adjusted: no, character traits and psychological complexes are not tied to specific diseases, and stress is not a trigger for the onset of a chronic disease, but only the cause of an exacerbation of an already existing pathology. This is what modern medicine thinks about psychosomatosis.
1. Hypertonic disease
It is the cause of 70-90% of all cases of high blood pressure. More than 1 billion people suffer from it, and about 40% do not know about it. It is based on a violation of the activity of the cardiovascular system, less often - of the kidneys or other organs and systems. Risk factors - heredity, lipid metabolism disorders, diabetes mellitus, overweight, smoking. But stress can become a triggering psychological factor during exacerbations of hypertension.
The situation "get excited - and the pressure rose" is familiar to many.
Franz Alexander believed that the hypertensive patient is "under a veil of unreacted emotions" that boil in him, finding no way out, and in the end bursting and tearing him from the inside. The metaphor is beautiful, but not always true. Over the age of 65 hypertension 60-80% of the world's population is sick, and among hypertensive patients there are people with a variety of characters. However, those who find it difficult to express emotions may experience stress longer, and in this sense they are more vulnerable. […]
2. Ulcer of the stomach and duodenum
Since Warren and Marshall received the Nobel Prize for their discovery of the bacterium helicobacter pylori, the main culprit in the formation of gastritis, duodenitis, stomach ulcers and the duodenum - a beautiful theory about "swallowed resentment", which cannot be "digested", and "eternal self-blame", which allegedly "stung" a person, has become the lot of alternative medicine. However, it is difficult to argue that with strong excitement, the activation of the sympathetic nervous system can disrupt the digestion of food in the stomach.
Before a difficult exam or with anxiety for a loved one, a piece does not climb into the throat - and we skip meals, and if we eat, we feel heaviness in the stomach.
Therefore, stress, especially prolonged, can provoke exacerbations of gastritis, ulcers and other diseases of the stomach.
I had a patient with panic attacks who was diagnosed by a gastroenterologist with gastroparesis, a disorder of the motor muscles of the stomach. They refused to work. As a result, the woman felt heaviness even after a small meal. Food "stagnated" in the stomach, the patient could not eat normally and lost a lot of weight. The reason was precisely sympathotonia as a result of high anxiety and sensitivity to stress. This problem meets quite often in young people. After treatment for panic disorder, the gastroenterological diagnosis was withdrawn.
3. Psoriasis
Stress has been proven to aggravate psoriasis. There is an increase in corticotropin-releasing hormone (CRH), which regulates the level of the inflammatory response. In psoriasis, CRH expression is also dramatically increased. Perhaps this hormone stimulates the production of interleukins in keratinocytes - small molecules that are involved in immune and inflammatory reactions. As a result, increases spread of psoriatic plaques. But to assume that psoriasis is caused by a violation of contact with the mother, as a result of which a person feels “thin-skinned”, “easily injured” and “not in his own skin”, is definitely not worth it.
4. Bronchial asthma
Asthma attacks can occur during stress. But not because the person has been "cut off oxygen" and he is trying to break the "suffocating care" from himself and "breathe life to the fullest." The point again is the activation of the sympathetic nervous system, which releases histamine into the blood, which narrows the airways. A respiratory attack at a time of severe stress can overtake not only asthma patients, but also people with psychosomatic diseases.
One of my patients with cyclothymia experienced actual choking attacks during mood swings. Along with the increase in energy, creativity and self-esteem, anxiety also imperceptibly increased, which caused the so-called affective-respiratory attacks, similar to the asthma clinic. Good diagnosis, good allergist (with my minimal help), saved the woman a lot of nerves: she already considered herself an asthmatic, but it turned out that she was not.
The remaining members of Alexander's Chicago Seven - autoimmune thyroiditis, ulcerative colitis, and rheumatoid arthritis - are not directly related to stress.
Both exacerbations and debuts of autoimmune diseases can occur against the background of strong feelings.
It is very difficult to investigate the mechanisms of this connection, since no one is free from acute stress, and the criteria and degrees of chronic stress are difficult to accurately define and measure. Therefore, evidence-based medicine is cautious about whether mental stress can trigger the onset or exacerbation of multiple sclerosis or another autoimmune disease. Most likely, as a factor that disrupts the body's homeostasis, stress can serve as one of the indirect causes of the disease. But the specific mechanisms for each of the diseases are still poorly understood.
Will stress always cause an exacerbation of gastritis or a hypertensive crisis? No. And here we return to the ideas of Franz Alexander: character still affects how events will develop. How exactly it will affect - we will discuss in more detail in chapter 22.
In the book "Truth and Myths about Psychosomatics" you will find a detailed analysis of the influence of the body and mind on each other, confirmed by evidence-based medicine. After reading, you will learn how physical and mental illnesses are connected and what to do if there is a problem, but doctors do not find anything.
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