A Model of People at High Risk to Develop Chronic Stress Related Symptoms

Enabling the somatizing patient to exit the somatic closet: A high-risk model.

“…This quiet but profound change on the health care stage (unknown to many if not most psychologists) has been termed the "Behavioral Medicine revolution" (Wickramasekera, 1988). It is in fact a major paradigm shift that requires an expanded legal definition of the word "physician" to include clinical health psychologists (Wickramasekera, 1984(Wickramasekera, , 1988. The legal and economic implications of this revolution are profound for psychology today, and will be even more so tomorrow, when primary care physicians realize what has happened.…”

“…One reason this process of diagnosis by exclusion is practiced is because there has been little systematic effort (Sternbach, 1966) devoted to the identification of specific experimentally testable positive psychological/psychophysiological findings that can account for physical symptoms independent of physical findings. The identification of such high-risk psychophysiological variables (Wickramasekera, 1979(Wickramasekera, , 1983(Wickramasekera, , 1984(Wickramasekera, , 1986(Wickramasekera, , 1987(Wickramasekera, , 1988 would have profound implications for diagnostic practice as well as for therapy and for primary prevention (Friedman & Booth-Kewley, 1987). For example, the presence of positive psychological findings in a patient can help the physician to inhibit a tendency to submit the patient to extensive physical investigations that could increase the probability of identifying and then treating a false positive physical etiology and producing an iatrogenic condition.…”

Applied psychophysiology: A bridge between the biomedical model and the biopsychosocial model in family medicine.

“…The high risk model of threat perception (HRMTP) provides nine quantitative psychophysiological risk factors that appear to amplify or reduce autonomic disregulation, promote somatization, and may eventually contribute to pathophysiology 2 (Wickramasekera, 1976, 1979, 1984, 1986, 1988, 1995; Wickramasekera & Atkinson, 1993). Three of these risk factors are hypothesized to block threat perception from consciousness: high or low hypnotic ability (Wickramasekera, 1979, 1988) and high covert neuroticism or “repression” (Weinberger, 1990). They are hypothesized to be psychological mechanisms that can increase the risk of incongruity (discrepancy) between subjective perception (consciousness of threat) and physiological or behavioral markers of threat perception.…”

“…In other words, these three risk factors can block threats from reaching consciousness, causing autonomic dysregulation (Wickramasekera, 1976, 1988). On the other hand, the following risk factors (Wickramasekera, 1979, 1988) are hypothesized to amplify the perception of threat: high hypnotic ability, high neuroticism or negative affectivity (Watson & Clark, 1984), major life changes (Holmes, 1981), multiple hassles (Kanner, Coyne, Schaefer, & Lazarus, 1981), low support systems (House, Landis, & Umberson, 1988), and low coping skills (Lazarus & Folkman, 1984). Incidentally, hypnotic ability is statistically unrelated (orthogonal) to all the above risk factors including high (17+) Marlowe–Crowne (Crowne & Marlowe, 1960) scores that are used to index high covert neuroticism (Wickramasekera, 1988, 1993, 1995).…”

“…Paradoxically, high hypnotic ability, depending on how it is used, can both reduce (block as in hypnotic analgesia or posthypnotic amnesia) or amplify (as in phobias or pain perception) the perception of threat. There are three hypothesized features of high hypnotic ability people that place them at risk for somatization: (a) their propensity to perceive involuntariness (lack of self-control) in perception, memory, and mood both within and outside of hypnosis during threat—this perception of events' occurring by themselves can spiral fear and depression; (b) surplus empathy (poor interpersonal boundaries); and (c) surplus pattern recognition, or the tendency to see meaning in events that are randomly distributed (Wickramasekera, 1979, 1988, 1995). These nine risk factors can be divided into predisposers: high or low hypnotic; high overt or covert neuroticism; high catastrophizing; triggers, including major life change and multiple hassles; and buffers, including a high number or satisfaction with social support and high coping skills.…”