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phenomenology and treatment of PSYCHOPHYSIOLOGICAL DISORDERS phenomenology and treatment of PSYCHOPHYSIOLOGICAL DISORDERS Edited by William E. Fann, M.D. Ismet Karacan, M.D., (Med) D.Sci. Alex D. Pokorny, M.D. Robert L. Williams, M.D. all of the Department of Psychiatry Baylor College of Medicine Houston, Texas MT~LIMlTED International Medical Publishers Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England Published in the US by SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace Jamaica, N.Y. 11432 Copyright © 1982, Spectrum Publications, Inc. Softcover :reprint of the hardcover 1st edition 1982 All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means without prior written permission of the copyright holder or his licensee. ISBN-13: 978-94-011-7291-2 e-ISBN -13: 978-94-011-7289-9 DOl: 10.1007/978-94-011-7289-9 Contributors GEORGE L. ADAMS, M.D. SABRI DERMAN, M.D., Ph.D. Professor of Psychiatry Department of Psychiatry Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas ROBERT ADER, Ph.D. A. SCOTT DOWLING, M. D. Departments of Psychiatry and Psychology Department of Psychiatry University of Rochester School of Case Western Reserve School of Medicine Medicine Cleveland, Ohio Rochester, New York PAUL E. BAER, Ph.D. WILLIAM E. FANN, M.D. Department of Psychiatry Department of Psychiatry Associate Professor of Pharmacology Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas WILLIAM H. BACHRACH, Ph.D., M.D. EMILE J. FARGE, M.D. Department of Medicine Department of Ophthalmology Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas STEPHEN A. BERMAN, M.D. ARNOLD P. FRIEDMAN, M.D. Department of Neurology Department of Neurology Baylor College of Medicine College of Medicine Houston, Texas University of Arizona Tucson, Arizona KELLY D. BROWNELL, Ph.D. Departments of Psychology and Psychiatry University of Pennsylvania Medical School CHARLES M. GAITZ, M.D. Philadelphia, Pennsylvania Department of Psychiatry Baylor College of Medicine and NORMAN DECKER, M.D. Department of Gerontology Department of Psychiatry Texas Research Institute of Mental Baylor College of Medicine Sciences Houston, Texas Houston, Texas EFRAIN A. GOMEZ, M.D. DAVID B. ROSENFIELD, M.D. Department of Psychiatry Department of Neurology Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas DAVID S. JANOWSKY, M.D. ALVIN P. SHAPIRO, M.D. Department of Psychiatry Department of Medicine University of California School of University of Pittsburgh School of Medicine Medicine San Diego, California Pittsburgh, Pennsylvania PONCE SANDLIN, M.D. ISMET KARACAN, M.D.(Med.} D.Sc. Department of Psychiatry Department of Psychiatry Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas ELIZABETH VENDITTI, B.A. PETER KNAPP, M.D. Department of Psychiatry Department of Psychiatry University of Pennsylvania Medical School Boston University School of Medicine Philadelphia, Pennsylvania Boston, Massachusetts HERBERT WEINER, M.D. JAMES W. LOMAX, M. D. Department of Psychiatry Department of Psychiatry Albert Einstein School of Medicine Baylor College of Medicine Bronx, New York Houston, Texas JEANINE C. WHELESS, B.A. DAVID PATON, M.D. Biological Sciences Research Center Department of Ophthalmology University of North Carolina Baylor College of Medicine School of Medicine Houston, Texas Chapel Hill, North Carolina ALEX D. POKORNY, M.D. ROBERT L. WILLIAMS, M.D. Department of Psychiatry Department of 'Psychiatry Baylor College of Medicine Baylor College of Medicine Houston, Texas Houston, Texas Contents Preface I. Psychological Elements of Gastrointestinal Disorders William H. Bachrach 2. Pulmonary Disorders and Psychosocial Stress Peter H. Knapp 15 3. Pathophysiological Aspects of Hypertension Alvin P. Shapiro 35 4. Psychophysiological Aspects of Headache Arnold P. Friedman 41 5. The Etiology and Treatment of Obseity Kelly D. Brownell and Elizabeth M. Venditti 51 6. The Effects of "Stress" and Conditioning on Immune Responses Robert Ader 89 7. Menstrual and Premenstrual Mood Disorders David S. Janowsky 107 8. The Couvade Syndrome: Its Psychophysiological, Neurotic, and Psychotic Manifestations Efrain A. Gomez, Ponce Sandlin, and George L. Adams 129 9. The Problem of Anorexia Nervosa: Psychobiological Considerations Herbert Weiner 143 10. Neurobehavior and Temporal-Lobe Epilepsy Stephen A. Berman and David B. Rosenfield 157 II. Childhood Aspects of Psychophysiological Disorders A. Scott Dowling 179 12. Some Psychophysiological Problems of the Elderly Charles M. Gaitz 191 13. Sleep Disorders and Their Psychiatric Significance Sabri Derman, Robert L. Williams, and Ismet Karacan 203 14. Stuttering David B. Rosenfield 229 15. Treatment Approaches to Psychophysiological Distress Norman Decker 235 16. Personality Correlates of Keratoconus Emile 1. Farge, Paul E. Baer, George L. Adams, and David Paton 243 17. Psychotherapy of Psychophysiological Disorders James W. Lomax 251 18. Psychopharmacology and Psychophysiological Disorders William E. Fann and Jeanine C. Wheless 259 Index 293 Preface The interrelationships between somatic and psychiatric complaints involve virtually every major organ system and every psychiatric diagnostic category. Psychiatric distress frequently finds expression in physical ailment or pain, and chronic physical illness or disability is a common exacerbant of psychiatric symptoms. The complexity of the interplay between psychological and physiological disease is profound, and many of the mechanisms involved remain undefined or imperfectly understood. Our intention in assembling this volume, the fifth in the Baylor Psychiatry Series, has been to consolidate the most recent medical and psychiatric opinion on the description and treatment of psychophysiological disorders. We have included reviews and new material on disorders long understood to be in the psychophysiological realm, such as gastrointestinal disease, pulmonary reactions, headache, and hypertension. Additionally, there are contributions on conditions less frequently, but no less clearly, recognized as psychophysiological or psychosomatic, including immune response deficits, epilepsy, stuttering, and sleep disorders. Chapters on Couvade syndrome, menstrually related mood disturbance, obesity, keratoconus, and anorexia nervosa examine the degree to which psychological and physical events interact in conditions usually considered attributable essentially to a single system. Drs. Dowling and Gaitz have written excellent reviews of developmental elements in psychophysiological events, and examine such disorders as they are specific to the very young or the very old. Treatment approaches to the variety of disorders are discussed in chapters by Dr. Decker, who describes multifaceted modalities, Dr. Lomax, who examines psychotherapeutic techniques, and in a final chapter on psychopharmacological mitigation of psychophysiological syndromes. The editors are grateful to the staff of Baylor College of Medicine's Office of Continuing Education for their competent assistance in conducting the symposium from which this volume grew. Bruce W. Richman, Assistant Professor in Baylor's Department of Psychiatry served as managing editor, as he has in each of the previous volumes in this series. We are particularly grateful to the following pharmaceutical manufacturers, who provided partial financial support for the program and again demonstrated their genuine interest in the continuing education of physicians and other health professionals: Boehringer Ingelheim Sandoz Pharmaceuticals Hoffman LaRoche Schering Corporation McNeil Laboratories Smith Kline & French Corp. Pfizer, Inc. phenomenology and treatment of PSYCHOPHYSIOLOGICAL DISORDERS Copyright © 1982, Spectrum Publications, Inc. Phenomenology and Treatment of Psychophysiological Disorders 1 Psychological Elements of Gastrointestinal Disorders WILLIAM H. BACHRACH The association of symptoms with an identifiable ("organic") lesion presumed to be the result of psychological factors is called psychosomatic disease. Symptoms for which no anatomical basis can be discovered, occurring in a setting of emotional stress, are conventionally described as psychofunctional or psychoph ysiological. With respect to the psychosomatic manifestations, we tend to be less concerned about identifying a precipitating emotional upset or a characteristic personality pattern or unconscious conflict because we do have reliable resources for bringing the somatic lesion under control. For achalasia we dilate the cardia; for peptic ulcer we have effective medical regimens and excellent surgical procedures. For the "functional" disorders, such as the irritable bowel syndrome, we have no uniformly successful medical or surgical measures. In these disoJders, therefore, we give special attention to identifying and dealing with the psychological problems underlying the symptoms. We approach this effort with more confidence once the diagnosis is reasonably established. Since the symptoms of psychophysiological reactions can simulate the symptoms of psychosomatic disease or disease with no psychological substrate, we rarely ever make the differential diagnosis directly. And this is reasonable. The patient with symptoms referable to the gastrointestinal system is entitled to a thorough evaluation with appropriate diagnostic measures, just as are patients with syndromes referable to other systems of the body. However, before the initial interview with the patient is over, the physician should have asked about possible psychological stresses in the patient's life, indicating that this is an important diagnostic possibility. If the diagnostic survey then rules out an "organic" cause, the patient should be reassured of the absence of serious disease and of the importance of recognizing that emotional conflicts underlie the symptoms. This approach extends to the patient an invitation to confide what it is that is bothering her or him (which, by this time, the patient is often ready to do if given permission).
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