The role of psychogenic and psychosocial factors in the development of functional voice disorders

Abstract

The primary objective of this discussion paper is to review the available evidence for the role of psychogenic and psychosocial factors in the development of functional voice disorders (FVD). Current theoretical models linking these factors to the aetiology of FVD and to vocal hyperfunction are then considered. Since there is a paucity of solid empirical evidence to date, general patterns of evidence derived from single case reports and case series are examined first, followed by those empirical studies using more sophisticated methodologies. The discussion is structured around a framework that includes the following psychosocial areas of enquiry: demographic profiles of individuals with FVD; stressful incidents preceding onset; personality traits; coping styles and psychiatric disorder. Current evidence and associated theoretical models suggest that cognitive, affective, neurophysiological and behavioural aspects culminate in the development of these complex voice disorders. The implications of these findings are discussed with respect to clinical practice and clinical training, with suggestions for future scientific research.

Investigating the Role of Salivary Cortisol on Vocal Symptoms

“…The association between increased muscle tension and acute and/or long-term stress has been affirmed by several studies both in laryngeal regions (Baker, Ben-Tovim, Butcher, Esterman, & McLaughlin, 2012;Baker, 2008;Dietrich & Verdolini Abbott, 2012;2014;Helou et al, 2013;Holmqvist, Santtila, Lindström, Sala & Simberg, 2013) and in neck and shoulders 1994, Lundberg, & Cooper, 2011. This relationship has been explained by Helou (2013) as "stress-induced acoustic changes in the voice are dynamic modifications to functions of respiratory, intrinsic laryngeal, extrinsic laryngeal, and the supralaryngeal muscles".…”

“…Additional explanations may include higher vocal effort in women (Södersten, Ternström, & Bohman, 2005) and the fact that women are overrepresented in occupations with many voice ergonomic risk factors (Vilkman, 2004). Research concerning gender difference in occurrence of vocal symptoms and stress (Holmqvist et al, 2013), results regarding functional dysphonia (Baker, 2008), primary muscle tension dysphonia research as well as research with no limitation on the type of voice disorders (Misono et al, 2014) showed higher occurrence of stress and vocal symptoms in women than in men.…”

“…Cortisol is released during stress and previous studies suggest that stress is a risk factor in developing vocal symptoms or dysphonia (Baker, 2008;Dietrich, Verdolini Abbott, GartnerSchmitdt & Rosen, 2008;Dietrich & Verdolini Abbott, 2012;Chen, Chiang, Chung, Hsiao & Hsiao, 2010;Gassull, Casanova, Botey, Amador, 2010;Lyberg Åhlander, 2011;Lyberg Åhlander, Pelegrín García, Whitling, Rydell & Löfqvist, 2014;Rantala, Hakala, Holmqvist & Sala, 2012). About 23-25% of individuals seeking care for voice disorders or with common vocal pathologies show stress scores deviating upwards from normal scores Misono et al, 2014).…”

How Do Teachers With Self-Reported Voice Problems Differ From Their Peers With Self-Reported Voice Health?

“…Baker [55] notes that the role of personality in the origin of voice problems has long been of great interest and various measuring methods have been used to investigate this issue. To investigate the possible role of personality in this population of teachers, the two subscales "Psychic Trait Anxiety" and "Adventure seeking" from the Swedish Universities Scale of Personality (SSP, 56) were used, providing a rough estimate of the commonly used dimensions of neuroticism and extraversion, respectively.…”

Relação entre os sintomas vocais, intensidade do desvio vocal e diagnóstico laríngeo em pacientes com distúrbios da voz

“…Voice disorders manifest in various ways, including the presence of sensory and auditory symptoms, deviations in vocal quality and functional and/or structural laryngeal changes that may involve behavioral and/or organic factors associated with their genesis and maintenance (1) . These disorders can have a negative impact on the patient's quality of life, compromising social, emotional, and work-related situations (2,3) . Patients with voice disorders may experience various symptoms, of which hoarseness, sore throat, vocal fatigue, and throat clearing are the most common.…”