Psychosomatic Medicine 11:273-281 (1949)
© 1949 American Psychosomatic Society

Special Features of Personality Which Are Common to Certain Psychosomatic Disorders

Evidence derived from psychiatric interviews and a consideration of comparative responsiveness of patients to psychotherapy has been assembled to support the hypothesis that certain patterns of personality malfunction are common to specific psychosomatic disorders.

An attempt has been made to indicate some of the behavior patterns which are sufficiently clear cut to be susceptible to rating on the basis of two to three psychiatric interviews, each of approximately one hour duration.

The responsiveness of patients to psychotherapy of various kinds also has been utilized in evaluating the nature and intractableness of personality malfunction.

The conditions considered were ulcerative colitis, hypertension, hyperthyroidism, rheumatoid arthritis, coronary diseases, peptic ulcer, bronchial asthma and, for purposes of comparison, palmar warts. Tables have been devised indicating the kinds of personality malfunction which have been frequently observed by many authors.

For example, in the case of hypertension, subnormal assertiveness and strong obsessive-compulsive trends have been observed as being most characteristic by most investigators. Saslow and associates have demonstrated by statistical studies of 50 hypertensive patients and two control groups of 50 each, matched for age, sex, education, color, culture and occupation that subnormal assertiveness and strong obsessive-compulsive behavior are significantly frequent in the hypertensive group. In contrast, impulsiveness, depression, hysteria, and anxiety were infrequently found. It is suggested that similar statistical studies would confirm the high frequency of strong dependent needs in patients who develop peptic ulcer, the frustrated search for mother love among asthma patients and the striving for authority among patients with coronary disease.

An additional factor in considering the treatability of patients with psychosomatic disorders lies in the nature of organ system involved. On the basis of the author's experience and a survey of the literature it has been concluded that psychotherapy of any kind, supportive, flexible or psychoanalytic, has no sustained effect in arresting the progression of hypertension. The same seems to be true of the patients with rheumatoid arthritis and with ulcerative colitis. Patients with hyperthyroidism respond moderately well to supportive psychotherapy but present special resistance to attempts at psychoanalytic therapy. In contrast, most authors agree that a high percentage of patients with peptic ulcer are remarkably improved by psychotherapy. The patients with coronary disease respond with arrest of symptoms relatively frequently to a simple variety of guidance and an authoritative type of psychotherapy. Bronchial asthma also responds readily to either brief psychotherapy or psychoanalysis. This marked difference in response to therapy seems to depend on certain personality factors as well as to the organ system involved. The patients who quite readily can be brought to express their underlying conflicts and find appropriate outlets for their energies, seem to be the ones who recover most readily. The hypertensive patients have extraordinary difficulty in expressing themselves and becoming aware of their bodily feelings or of expressing their emotions. Compulsive and obsessive qualities also are important in delaying recovery under psychotherapy.

In the future reporting of studies of psychotherapy in patients with psychosomatic disorders, special attention should be paid to these differences in syndromes and to specific personality maladjustments as well as to detailed psychodynamic formulations. In presenting the results of psychosomatic studies to our medical colleagues, psychiatrists should be careful in pointing out the types of disorders that are particularly resistive to psychotherapeutic measures and to avoid the past tendency to imply that practically all these cases recover under psychotherapy.

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