Psychosomatic Medicine 13:314-321 (1951)
© 1951 American Psychosomatic Society

Psychosomatic Disorders in Psychoses

¹ Boston State Hospital
² Boston State Hospital, 591 Morton Street, Dorchester 24, Massachusetts

A review of the literature pertinent to the incidence and significance of psychosomatic disorders among psychotic patients is presented and a survey is reported pertaining to the incidence of psychosomatic syndromes existing in patients admitted to the Boston State Hospital during the year beginning April 1, 1948, and ending March 31, 1949.

During this period of time there were 1348 admissions to the Boston State Hospital, of whom 314 were discharged as being nonpsychotic. Of the remaining 1034 psychotic patients 578 were in the age group 16-60 with which we were concerned. A total of 20 patients of this group were discovered to have psychosomatic disorders--an incidence of 3.4 per cent. The incidence in the nonpsychotic group was 4.5 per cent. The incidence of psychosomatic disorders was then quite low in this total population--and lower in the psychotic than in the nonpsychotic group.

The psychosomatic disorders which these 20 patients had were headache, hypertension, dermatitis, mucous colitis, asthma, peptic ulcer, and epilepsy.

The patients were classified into three groups according to the relation between psychosomatic disturbance and psychosis. Category I included those patients whose psychosomatic disorders subsided or disappeared with the onset of or during the psychosis; patients whose symptoms fluctuated with variations in the material and processes uncovered during the course of psychotherapy; and patients whose psychosomatic disorder became worse as the psychosis began to improve. Category II includes patients with psychosomatic syndromes that were unaffected by the psychosis as well as patients from whom no correlating material could be obtained because contact could not be established with the patient. Category III includes patients whose psychosomatic disorders were aggravated during the course of the psychosis.

No correlation was found to exist between the specific psychosomatic and psychotic diagnoses. Thus although headache was the most common psychosomatic disorder and occurred in 6 of the 11 schizophrenic patients, it also occurred in 2 of 3 manic-depressive patients. It is to be noted, however, that those patients who had headaches prior to the psychosis did tend to be relieved of their headaches even when the psychosis improved.

Certain phenomena, such as obesity and transient elevation of blood pressure were observed but it is hoped will be made subjects of further study. The obese patients all maintained an extremely defensive attitude about their obesity warding off any discussion of it with persistence and rigidity. The patients with transient hypertension all demonstrated this phenomenon on admission to the hospital indicating that these psychotic patients were capable of reacting to a new situation at least in a physical way.

Many common psychosomatic disorders did not appear in the patients admitted during the year's admissions surveyed.

This study suggests that psychosomatic and psychotic disorders do not occur in the same person very frequently as clinical entities. It would appear that the psychotic individual does not very often use a psychosomatic disorder as a mechanism of defense.

This article has been cited by other articles:

				O. Von Mering Disease, Healing and Problem Solving: a Behavioural Science Approach International Journal of Social Psychiatry, April 1, 1962; 8(2): 137 - 148.