Types of Psychomedical Disorders

 The BHI 2 began with a broad theory of the interaction between psychological and medical disorders. Bruns, Disorbio and Disorbio (2003) referred to this as the theory of "Psychomedical Disorders." This was an attempt to create a single construct which incorporated such diagnosis as somatoform disorders and somatization, reactive psychological disorders, factitious disorders, psychophysiological disorders and others.

It was hypothesized that all serious medical disorders tend to give rise to a significant psychological component. Conversely, all serious psychological disorders tend to present with a significant medical component as well. They defined a Psychomedical Disorder as any disorder in which related psychological and medical conditions could both be diagnosed. This would by definition include any DSM-IV diagnosis where an Axis III condition was diagnosed. These disorders were categorized into four different types:

 

 

Types of Psychomedical Disorders

(Adapted from Bruns, Disorbio and Disorbio, 2003)

Reactive Disorders

Psychological disorders where a psychological reaction occurs as a result of a medical condition. For example, a person who is diagnosed with terminal cancer could react psychologically with a panic attack, anger or severe depression.

Psychophysiological Disorders

Disorders in which psychological problems give rise to real organic difficulties. For example, a person who is exposed to severe stress may develop problems with blood pressure, headaches, gastrointestinal distress or other sorts of medical disorders.

Somatoform Disorders

Disorders in which psychological factors give rise to the experience of medical symptoms. For example, hypochondriasis is a condition where a person is convinced that he or she is suffering from a particular disease, despite objective medical information to the contrary.

Endogenous Disorders

Disorders in which medical conditions directly produce a psychological disorder. For example, persons with hypothyroidism may experience depression as a result of the hormonal imbalance.

In any of these disorders, comprehensive and effective treatment must address both the medical and the psychological components of the condition.

Given the importance of behavioral health interventions it seems likely that the field of health psychology will grow substantially in the years to come. For this to happen, both the psychological and the medical profession must learn new ways of practicing and coordinating care. A comprehensive assessment of psychomedical disorders generally involves both medical and psychological input.

 

Table 2. Psychomedical Disorders

(From Bruns, Disorbio and Disorbio, 2003)

Type of

Mind-Body Connection

 

Origin of Disorder

 

Physiogenic

Psychogenic

 

 

Organic Psychological Disorders

Psychophysiological Disorders

Physical Connection

Sample Types:

Depression due to hypothyroidism, brain injury

Tension headaches, unhealthy lifestyle, bracing, factitious disorders that involving harm to self

Mechanism:

Illness or injury has direct effect on emotions, cognition, or personality

Chronic autonomic arousal or unhealthy behaviors lead to organic changes

Example:

Person becomes short-tempered and impulsive after brain injury

Chronically tense keyboardist develops pain in neck and shoulders

Psychological Treatment:

Psychological support, compensatory strategies, symptom management, address lifestyle changes (e.g., diet, exercise, smoking cessation)

Stress management, biofeedback, relaxation training, psychotherapy to address the emotional distress and make lifestyle changes (e.g., work habits, exercise)

Medical Treatment:

Appropriate medical treatment for illness/injury, medication as needed for depression or anxiety, or to stabilize central nervous system

Medications (e.g., anxiolytics, antidepressants, or muscle relaxants) to interrupt the “fight or flight” response

 

 

Reactive Psychological Disorders

Somatizing Disorders

Psychological Connection

Sample Types:

Injury or illness with reactive depression

Somatization, pain disorders, conversion disorders, factitious disorders, malingering

Mechanism:

Emotional reaction to organic problem

Misperception or exaggerated report of physical symptoms with no organic basis

Example:

Patient is diagnosed with a terminal condition and has a panic attack

Person reports severe pain to escape unpleasant job

Psychological Treatment:

Psychological support, address anxiety, depression, symptom management, address lifestyle changes (e.g., diet, exercise, smoking cessation)

Psychotherapy to address underlying somatized concerns, psychological management of primary or secondary gain

Medical Treatment:

Appropriate medial treatment illness/injury, medication as needed for reactive depression or anxiety

Medication for any underlying and somatized depression or anxiety

 

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