Elsevier

Psychoneuroendocrinology

Volume 30, Issue 10, November 2005, Pages 996-1002
Psychoneuroendocrinology

Psychobiological perspectives on somatoform disorders

https://doi.org/10.1016/j.psyneuen.2005.03.018Get rights and content

Summary

Common physical symptoms such as abdominal pain, headache, back pain and dizziness play a major role for the health care system. Existing models for the development and maintenance of these symptoms emphasize a vicious circle with cognitive-perceptual, behavioral, and psychobiological components. In this manuscript, we present examples of psychobiological factors that might contribute to somatoform disorders. We emphasize that somatoform symptoms are not strictly mental events, but are associated with a diversity of biological processes. The possible role of the endocrine and immune system, amino acids and neurotransmitters, but also physiological activation and cerebral activity is exemplified. These approaches are categorized using a model of perception and filtering of bodily signals. Studies are needed that combine the investigation of different biological systems with assessments of psychological variables in longitudinal trials, but also experimental investigations in humans examining the interaction of behavior changes, biological variations, and body perception are still rare.

Section snippets

Autonomic physiological arousal

Somatoform symptoms could in theory result from heightened physiological activity. Increased physiological activation increases the likelihood of perception and misattribution of bodily signals. Although it is evident that perception is substantially influenced by psychological factors, physiological activation of variables such as heart rate or others could still play an independent role (Wientjes and Grossman, 1994). Empirical investigation of this basic hypothesis is less frequent than

A signal-filtering model of somatoform symptoms

Somatoform disorders can be understood as disorders in the perception of bodily signals. Therefore, all biological approaches have to be discussed in light of their possible influence on the perception of bodily signals. To facilitate this process, we will present a simplified model consisting of signal development, filtering, and perception.

We assume that most body parts send sensory signals to the brain. Due to neural filtering processes, most of these signals do not come to consciousness in

Replication and extension of existing approaches

It is evident that many of the findings cited above should be replicated before further interpretation. They present exciting options, but are not comprehensive and should therefore be extended.

Examination of covariation of different features, longitudinal studies

We know more and more about components of somatoform symptoms, but little about their interaction, sequences, etc. although all vicious circle models include assumptions about it. In addition to biological features, behavioral components (such as reduction of physical activity, health care use, social

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