Anxiety and Psychosomatic Illness

Abstract

Since the DSMIII no longer classifies illness as psychosomatic, we must immediately redress the title of this paper (1). Rather than using the term psychosomatic illness, the new classification would list the specific psychiatric disorder as the primary diagnosis (Axis I) and the co-existing pathophysiologic disorder under Axis III. As an example, in a patient with mitral valve prolapse accompanied by panic, the Axis I would be anxiety disorder (panic disorder) and the Axis III would be Psychological Factors affecting Physical Condition. Such classifications tend to eschew a specific or directional relationship between the two. The wisdom of this causal-directional separation is questionable. To a large extent, it tends to disestablish the specificity theories that dominated earlier concepts regarding the psychogenicity of specific diseases such as Alexander’s holy seven: ulcerative colitis, rheumatoid arthritis, hyperthyroidism, hypertension, peptic ulcer, bronchial asthma, neuro-dermatitis (2). In so doing, it may once and for all abolish the idea that some diseases are more psychosomatic than others. Rather, the new classification would allow the idea that any illness, mental or somatic, may be accompanied by symptoms relative to one or the other. Thus, the patient with a parimary affective disorder with vegetative symptoms and signs is as likely to be viewed as somatic as well as mental in his assessment, diagnosis and treatment. On the other hand, a patient with symptoms and signs of ulcerative colitis might have manifestations of anxiety which would be identified respectively in Axes III and I. The relationship of anxiety to ulcerative colitis might be generative, derivative, or independent of the latter. Each, however, is treatable in its own right, a practice that has preceded the above formulation.