Somatic Symptoms and Depressive States

Depressive states, from both phenomenological and symptomatic points of view, often include such bodily disturbances as insomnia or hypersomnia, anorexia, weight loss, loss of energy and libido, anhedonia, psychomotor agitation or retardation, and difficulty in thinking or concentrating. These vegetative signs may move into more elaborated somatic constellations, such as headaches, backaches, or chronic pain, and may involve any organ system: the central nervous system, the peripheral nervous system, or the cardiovascular, respiratory, genitourinary, gastrointestinal, or endocrine systems.

Although solemnization may be symptomatic of hysteria, anxiety disorders, obsessive-compulsive character pathology, borderline conditions, or grief reactions, many researchers suggest that somatization most frequently is represented I effective disorders and particularly in major depression Somatization is seen as serving the function of masking depression somatizers do not necessarily present with depressive affect and may instead  Find their way t primary care physicians to seek relief for their presenting somatic complaints.

As reported in a extensive review of the empirical literature research studies using various depression inventories indicat that when depression is not self-reported, but presents a somatic symptoms to primary care physicians, the diagnosis o depression is missed in more than 95 percent of the cases.

Eve more importantly, 20 to 45 percent of the patients of primar care physicians are estimated to be significantly depressed.


What accounts for the somatic presentation of affective states?

It has been suggested that somatic symptoms are amplifications of normal physiological sensations that become distorted through hyperawareness, hypersensitivity, and selective attention.

Cultural factors, including cultural inhibitions against the direct experience of depressive and the lack of vocabulary for emotional expression, have also been implicated.

Somatization appears related to increased age, family history, and previous physical illness; it appears to decrease as socioeconomic status gets higher.

Symptoms most commonly expressed in depressive patients are those of the autonomic nervous system (sweaty palms, trembling, tachycardia, perspiration, and breathlessness), sleep disturbances, dry mouth, and fatigue , which suggest an association between depression and anxiety.

Some researchers  suggested a relationship among character traits, family history, and somatization.

Several differences were found in comparisons of depressives who had no localized somatic symptoms to depressives with chest symptoms of nonexertional breathlessness, including sighing respiration and acute hyperventilation; heaviness in the sternum; and depressive themes of preoccupation with death from chest and heart disease.

Depressives with chest symptoms tended to be more obsessional, to recall prolonged breathlessness in a parent, and to have lost a first-degree relative within the past three years, suggesting that issues of identification and of loss may be related not only to somatization but to the particular somatic symptoms involved.

In the medical literature, somatization of depression traditionally has been described as an unconscious defensive maneuver on the part of the patient with the assumption made that intrapsychically focusing on somatic symptoms instead of on an emotion will protect the person from psychological pain.

Cross-cultural and historical perspectives reveal that depressives in non-European and nonwestern cultures tend to somatize much more frequently, which suggests that somatization is a cultural orientation.

Goldberg and Bridges saw somatization as a basic mechanism of the human species for responding to stress. They postulated that in societies in which the individual tends to be submerged in the group, somatization is a relatively common means of expression of stress. In individualistic societies, which tend to the narcissistic idealization of the self, somatizing has been replaced by psychologizing, a more recent cultural orientation.

In a study carried out in an urban area of England, Goldberg and Bridges collected groups of psychologists and automatizes who were interviewed and asked to complete various personality and attitude scales. Interestingly, although psychologists and automatizes were equally anxious, psychologists were much more likely to report depression than were automatizes.

Given the relationship between depression and stigmatization, the finding seems contradictory on the surface. However, the authors posited that systematization functions as a defense against blame. Those who stigmatize tend not to report depression, nor do they see themselves as mentally ill or as responsible for their life predicaments. Inferential, we might then posit that those who acknowledge their affect, and see themselves as agents in their own lives, automatize less.

Goldberg and Bridges asserted that, in automatizes, blame is handled through projection (for example, a Yoruba who attributes his bodily symptoms to witchcraft), through interjection (for example, a hypochondriacal Britisher who attributes his bodily symptoms to undiagnosed cancer), or through a combination of both (for example, a person who believes she has some sort of disease which the doctor has been unable to diagnose, and it’s the doctor’s fault.


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