This document discusses psychosomatic disorders, which involve physical symptoms caused by mental or emotional factors rather than physical pathology. It defines psychosomatic disorders and outlines the psychological and physiological mechanisms by which stress can influence bodily functions. Specifically, it describes how stress activates the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, releasing hormones like cortisol and catecholamines that can induce immune, inflammatory, and pain responses when the body is chronically stressed. The document also introduces the concept of somatization, where psychological distress becomes manifested as physical symptoms.

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PA R T 1 : I N T R O D U C T I O N
TO P S Y C H O S O M AT I S M
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3. • Involves both body and mind.
• Have physical symptoms originating from mental or
emotional causes like stress, anxiety and
depression.
• There is a rapid upsurge in prevalence rates of
psychosomatic disorders in past few decades
globally as a consequence of rapidly changing
modern life style of people as well as long standing
INTRODUCTION:

4. • The term “Psychosomatic” was first used in 1818
by the German psychiatrist, Heinroth.
• Felix (Deutsch) in 1922 -"psychosomatic
medicine"

5. • “Diagnostic and Statically Manual, Mental
Disorder” (DSM-1) in 1952 as “Psychosomatic
Disorders”

6. • Psycho-physiologic disorder.
• Psychological symptoms either AGGREVATE /
INITIATE disease.
• An improper stimulation of the ANS, which regulates
the functions of the internal organs, is responsible for
the evolution of disorder and leads to impairment of
the functional organs.

8. • A group of ailments in which emotional stress is a
contributing factor to physical problems involving organ
system under involuntary control.
DEFINITION

9. • Psychosomatic disorders DSM-II, (1968) defines
Psychosomatic Disorders as psychosomatic symptoms
that are caused by emotional factors and involves a
single organ system, usually under autonomic nervous
innervations.

10. • DSM 1V defined psychosomatic(somatoform
disorders ) as PRESENCE OF ONE OR MORE
physical symptoms without an adequate medical
explanation that causes severe distress or
impairement in functioning.

11. • Defined as a physical, mental or emotional response
to events that causes bodily or mental tension.
• It is an undesirable or health threatening response of
the body, which is brought on by deleterious external
influences (stressors).
stress

12. • It is an unpleasant emotional state characterized
by fearfulness and unwanted and distressing
physical symptom.
Anxiety

13. The psychological factors include:
• Mental disorders (e.g., Major Depressive Disorder)
• Psychological symptoms (e.g., depressed mood or anxiety)
• Personality traits or coping style (e.g., denial of need for
medical care)
• Maladaptive health behaviors (e.g., smoking or overeating)
• Stress-related physiological responses (e.g., tension
headaches)
• Other unspecified psychological factors (e.g., interpersonal
or cultural factors)

14. • Nervous system markers, such as adrenaline, noradrenaline, and
dopamine.
• Endocrine system markers, such as corticoids (Cortisol, 17-
hydroxycorticosteroid and aldosterone) in the blood, urine and
saliva, and ACTH in the blood.
• Immune system markers, such as the total number of lymphocytes
and its subsets T cells, B cells and natural killer cells,
immunoglobulin’s, and cytokines such as interleukin (IL)-1, IL-2, BL-
6, interferon (IFN) and tumor necrosis factor (TNF).4,5
Stress biomarkers

15. • Stress acts or potentiates
the Hypophyseal Pituitary-Adrenal axis (HPA axis),
leading to increased serum corticosteroid levels, which is thought
to have anti stress effects.
Endocrine responses to stress

16. • Stress
• Hypothalamus
CRF
• Pituitary
ACTH
• Adrenal cortex
• Corticosteroid release
• Increased steroid level

17. Schematic representation of the interaction between glucocorticoids, orexins, and the
cholinergic system in regulating stress responses . Stress activates the release of
glucocorticoids from the adrenal gland, which then feedback into the brain and target both the HPA
axis and extra-hypothalamic sites like the hippocampus and the amygdala. Orexins also activate
the HPA axis and lead to the production of glucocorticoids and stimulate the release of CRF from
the PVN of the hypothalamus and the central amygdala. The third player are the nicotinic receptors
(nAChRs) which indirectly regulate ACTH release by acting on the PVN.

18. • Corticotropin releasing factor (CRF) can stimulate norepinephrine release via CRF
receptors,
• which activates the sympathetic nervous system and increases epinephrine release
from the adrenal medulla.
• In addition, there are direct links of norepinephrine neurons that synapse upon
immune target cells,
• Thus, in the face of stressors there is also a profound immune activation, including
the release of humoral immune factors (cytokines) such as interlukin-I (IL-1) and
IL-6.
• These cytokines can themselves cause further release of CRF, which in
turn serves to increase glucocorticoid effects and thereby self -limit the
immune activation.

19. • Stress releases catecholamines from the autonomic nervous system
• Activates the
 Serotononergic and
 Dopaminergic systems
which increases serotonin turnover leading to release of:
 Corticotrophin releasing factor (CRF),
 Glutamate and
 GABA.

20. • Thus, traumatized or chronically stressed individuals may determine
• an increased vulnerability to bodily disorders, promoting a
disinhibition of immune disorders, inflammation, chronic pain
syndromes and allergies.

21. • Emotional and psychological factors can disturb a wide variety of
 hormonal,
 vascular and
 muscular functions,
all of which may produce peripheral changes varying from pain,
disturbance in jaw movement, xerostomia and ulcerations.

22. Term used to describe the process whereby an individual’s psychological &
social distress are manifested as bodily symptoms that cannot be wholly
attributed to organic pathology.
SOMATIZATION:

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P A R T 2 : C L A S S I F F I C A T I O N O F O R A L
P S Y C H O S O M A T I C D I S O R D E R S &
A T Y P I C A L O R O F A C I A L P A I N
P A R T 3 : O T H E R O R A L P S Y C H O S O M A T I C
D I S O R D E R S