Symptom Formation Reconsidered in Psychosomatic Terms

Abstract

A classifying system is presented for interpreting physical symptoms in childhood disorder under three main headings. The first of these is the somatopsychic sequence in which the basic substrate is an organic lesion giving rise secondarily to intellectual and emotional repercussions. The second pattern is the pseudosomatic sequence in which the symptom presentation, though physical, has a basis of purely emotional pathology. The third pattern is the psychosomatic sequence which, it is suggested, should be retained for those specific disorders like asthma, eczema, migraine and spastic colon, which have a pathophysiological substrate activated by emotional factors, so that the resulting disorder has a conjoint aetiology. The principle common to all three syndromes is that symptom formation is dependent first upon the lesion itself (its nature, duration and severity); secondly, upon the child’s attitude to it; and finally, upon the parental attitude to it.

Clinical Prediction of Medical Rehospitalization: Psychological Assessment with the Battery of Asthma Illness Behavior

“…While numerous studies have retors serve to maintain, perpetuate, and ported empirically significant relationexacerbate physical illness (Dirks, Fross, ships between various component scores & Paley,, 1978; on the BAIB and subsequent medical & Dahlem, 1979). Over the last several judgment of illness severity (Dirks, Horyears, there has been a steady emergence ton, , inof both theoretical articles (e.g., Engel, tensity of medical treatment Lipowski, 1970;Pinkerton, 1974 and empirical research documenting the Kinsman, Jones, Spector, Davidson, & interrelationship of psychologic factors Evans, 1977), and long-term medical with type and severity of physical illness outcome (Dirks, Fross, & Paley, 1978;in influencing medical judgment, medi-Staudenmayer et al, 1979), the clinical cal treatment, and medical outcome(e.g., utility of the entire BAIB has yet to be Dirks, Fross, & Paley, 1978;Kleiger & tested. As an example, a previous study Dirks, in press;Staudenmayer, Kinsman, (Dirks, Fross, & Paley, 1978) demon Dirks, Spector, & Wangaard, 1979; Zim-strated wide variability among nine ikano, Dirks, Kinsman, Davidson, & groups defined by two components of Damle, 1979). This growing body of lit-the BAIB (i.e., panic-fear personality erature demonstrates the need for assess-scores and panic-fear symptom scores) ment procedures to identify psycho-in rehospitalization rates within six maintenance potentials early in the months after discharge from the National course of medical treatment, in order Jewish Hospital and Research Center that effective psychologic treatment be (NJHRC).…”

Paediatrics and child psychiatry. The case for collaboration.

“…It follows therefore that by subtracting from the cumulative build-up at any stage in the sequence, therapeutic benefit should result (Pinkerton, 1974).…”