Psychosomatics - causes of cardiovascular diseases. Psychological causes of cardiac ischemia

The term “psychosomatics” was first used by R. Heinroth in 1818, and for more than one hundred and fifty years the psychosomatic direction in medicine has been an arena of heated controversy. The idea of ​​psychosomatosis is based on the assertion that in the origin of a number of somatic diseases, the leading place belongs to psycho-emotional factors. Thus, psychosomatic pathology is a kind of somatic resonance of mental processes. The so-called true psychosomatoses include: coronary heart disease, bronchial asthma, hypertension, duodenal ulcer, ulcerative colitis, neurodermatitis, nonspecific chronic polyarthritis.

Let's take a closer look at coronary heart disease. The occurrence and course of IHD is the result of a complex of pathogenic factors. The role of some has been shown quite convincingly in scientific research. The role of others - psychological, psychosocial - has also been established and reflected in the works of the last 20-25 years. Scientists have drawn parallels between the “infarction” nature and the occurrence of coronary heart disease. The result of these studies is the book by M. Friedman and R. Roznman “Type A Behavior and Your Heart” and a number of subsequent publications. Character traits classified as type A are: internal tension, intolerance, desire for constant leadership, compulsivity, emotional instability. “The brain cries, but the tears are in the heart” - this is how the famous scientist R.A. figuratively said. Luria. But is it only the brain that cries? And what is the basis of the “sick” behavior of type A? First of all, it is a sin committed in the depths of the human spirit, which arouses passions, affects character, and deprives one of peace of mind. “What comes from a person defiles a person; for from within, from the human heart, come evil thoughts, adultery, fornication, murder, theft, covetousness, malice, deceit, lasciviousness, an envious eye, blasphemy, pride, madness: all this evil comes from within and defiles a person.”

Consequently, the origin of psychosomatic illness can be sketchily represented as a process of somatization of sin: sin - character - illness. It has been established that the occurrence of bronchial asthma is associated with the presence of pronounced traits of assertiveness and intolerance in the character. Thyroid diseases can be caused by excess. With obliterating endarteritis, timidity is detected.

Of course, this scheme should be taken with caution and is applicable only to some cases. By the will of the Lord, illnesses can be given to a person as a test of faith and even as a reward for those who rejoice in painful hardships endured for the sake of God and eternal life. I was lucky enough to venerate the incorruptible relics of such a saint, our venerable father Pimen the Much-Sick, in the Kiev Pechersk Lavra. Thus, depending on the spiritual “soil” on which ailments arise, their meaning is determined. But in all cases, the Lord calls to Himself, and in all cases, repentance, prayer and daily work on oneself are necessary. Issues of spirituality and morality are inseparable from issues of illness and health. I am sure that a psychotherapist who neglects the spiritual roots of diseases and recognizes only psychosomatic relationships will not be able to provide effective help, and his efforts risk turning into “running in circles.”

Clinical Department for the Study of Borderline Mental Pathology and Psychosomatic Disorders of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences, Moscow; Clinic of Cardiology of the Moscow Medical Academy named after. THEM. Sechenov.

Coronary heart disease, occurring with psychogenically provoked myocardial infarction and myocardial ischemia, can be classified as a psychosomatic disease. We observed 70 patients aged from 39 to 77 years, average age 61.2±9.9 years, of whom 17 were women and 53 men. Obligatory for the manifestation or exacerbation of this variant of coronary artery disease is the presence of not only a somatic, but also a mental predisposition. The position has been put forward about the existence of heterogeneous in nature types of vulnerability of coronary vessels affected by atherosclerosis to the effects of adaptation." Psychoemotional stress disrupts the compensatory mechanisms of self-regulation of basic physiological functions, biological rhythms, as well as the barrier functions of the body, there is a change in the immunological reactivity of the body and the progression of psychosomatic pathology.Unsatisfactory adaptation of patients who have had an MI affects the quality of life of patients, reducing their working potential and longevity.

It has been established that anxiety and depressive-hypochondriacal disorders predominate in cardiovascular patients. The occurrence of these disorders is associated with premorbid personality characteristics and the course of coronary heart disease. Thus, the most pronounced psychopathological disorders were identified in post-infarction cardiosclerosis, when cardiac pain is associated with angina, as well as with concomitant arterial hypertension. According to G.V. Sidorenko, in patients with coronary heart disease, the hypochondria scale scores are significantly increased compared to healthy people.

V.N. Ilyina, E.A. Grigoriev studied psychosomatic relationships in cardialgia of puberty and menopause. It turned out that the clinical manifestations of cardialgia in both age groups depended on personal characteristics and attitudes towards overcoming age-related illnesses. Character traits such as suspiciousness, impressionability, pessimism, and irritability were sharpened, which created fertile ground for various vegetative manifestations. Increased vegetative dysfunction reduced tolerance to difficult situations. A vicious circle was created that was difficult to overcome even with an active attitude towards struggle.

In any society, the role of the patient is “technologically” laid down, defining a system of normative properties and associated assessments that bear the imprint of a given culture. In every culture there is a stereotype, the status of the patient. In every culture there is also a stereotype of how a postoperative patient is perceived. Thus, for patients who, for example, come from surgical clinics into life, the social environment turns into certain facets. The information existing in society about a person as a patient who has undergone surgery creates a system of certain expectations towards him on the part of people who interact with the patient.

The system of role relations is not a passive structure. It is like a “network” of lines along which the energy and activity of the person assigned to the role of the patient is directed. First of all, a person’s activity and energy is directed by his immediate environment, as well as by the social system as a whole. Along these “lines” human activity can be carried out most easily, without encountering resistance; on the contrary, a person is, as it were, “pushed” in a certain direction. If a person internally does not agree with the role of the patient offered to him by the social environment, which sets the character and direction of his mental activity, he has to overcome a certain “resistance” of the social environment. This can make it difficult for a person to readapt, especially in those conditions when he is weakened by a serious illness and surgery, and has not sufficiently restored his physical potential.

Thus, an important factor influencing changes in the motivational structure of the individual in connection with the disease and the reflection of these changes in the internal picture of the disease are sociocultural stereotypes of the disease, which form the system of expectations of society in relation to the sick person.

V.V. Nikolaev and E.I. Ionova conducted a study of the personal characteristics of patients with coronary artery disease who underwent coronary artery bypass surgery.

Patients with coronary artery disease with a lower educational level, as well as those who were engaged in physical labor before illness, focus on maintaining health as the highest value. It is characteristic that in the initial period after surgery, the choice between an orientation toward health and an orientation toward the values ​​of life often appears exaggerated for the patient. Patients either strenuously justify the pointlessness of further production activities and make difficult plans for a further quiet life, or do not want to remain without work for a day after leaving the hospital. The third category of patients, trying to combine the consequences of the disease with their previous way of life, are in a painful state of solving a difficult task that seems impossible to them.

All patients have high anxiety, the nature of which changes with increasing duration of the postoperative period. At the stage immediately after surgery, it has a more physiological sensory nature and is associated with the consequences of surgery, anesthesia and artificial circulation. Later, the phenomenon of anxiety changes quite quickly, anxiety is associated with obstacles and the threat that the disease creates for the individual. In addition to verbal forms of expression, high anxiety is manifested in the behavior of patients, demeanor, sudden emotional outbursts, especially when the topic of clinical conversation concerns the future of patients. In general, anxiety in most patients is of a latent nature, which intensifies with increasing duration of follow-up.

During the year after surgery, the tension and anxiety of patients outwardly decreases. There is a relative adaptation of patients to the changed life situation, which is probably not always successful from a psychological point of view.

Patients with a postoperative period of 2-4 years have a newly established lifestyle. It represents a complex picture of closely intertwined problems reflected in the patient’s motivational sphere. The problems look especially confusing if a person does not work for all the years after the operation. In this case, the disease sometimes ceases to be perceived as a center around which life’s difficulties are layered, but only as one of the equally insurmountable obstacles that fill all areas of the patient’s life. A person develops an established opinion about the difficulties of his life as inevitable, as his fate.

The material collected by the method of structured clinical and psychological conversation suggests that the prognosis for psychological rehabilitation is more favorable the more acute the onset of coronary heart disease, the shorter the period from the onset of the disease to surgery, and the fewer heart attacks the patient suffered. The most favorable age from the point of view of prognosis for psychological rehabilitation is probably 35-45 years. Patients who have undergone CABG surgery at this age most often experience successful social readaptation. More favorable in terms of rehabilitation are those cases when the “peak” of the psychological crisis associated with a sharp change in the usual course of life as a result of the disease occurs in the preoperative period. Obviously, in this case, patients are psychologically prepared in advance for the difficulties of the postoperative period.

It was also confirmed that the rehabilitation process is more successful if patients are working at the time of the onset or exacerbation of the disease than in cases where they are disabled for some reason at the time.

Thus, the analysis of the data obtained using the questionnaire revealed some characteristic personality traits and the internal picture of the disease in patients with coronary artery disease who underwent CABG surgery, which are formed under the conditions of specific features of the relationship of patients with the social environment. Patients are characterized by a strong desire for recovery and readaptation, which, however, they are often unable to independently implement due to certain personal characteristics. The desire to form a strong-willed, strong “I”, characteristic of patients, can, under certain conditions, act as an independent goal, giving rise to a desire, which is a protective strategy of the individual, to maintain a high level of self-esteem and self-respect by any means. Analysis of the internal picture of the illness of this group of patients outlines one of the layers of this conflict. The results of this analysis recreate the picture of the difficulties that a person with such an internal strategy encounters on the path of awareness of his internal states, not consciously preferring external means of overcoming the disease to the processes of internal restructuring of the motivational structure of the personality and the inclusion of the situation of the disease in this structure. The most pronounced emotional disorders are observed in patients who have suffered a myocardial infarction. Even with satisfactory health, the diagnosis of myocardial infarction is associated in patients with a threat to life. Severe physical condition, severe weakness, intense pain, concerned faces of medical personnel, urgent hospitalization - all this gives rise to anxiety and fear, leading patients to the belief that their lives are in danger. The mental state of the patient in the first days of illness is also influenced by other psychological factors. Patients are depressed by the thought that from strong, strong, active people they have turned into helpless patients in need of care. Usually, as physical well-being improves, the fear of death weakens. Along with alarming fears for health, gloomy thoughts about the future, depression, fear of possible disability, and anxious thoughts about the well-being of the family appear. Without appropriate intervention, these disorders become established and persist for one year in 25% of survivors. According to other data, mental disorders were detected in 28% of cases. Intensification of neurotic features was observed in 50% of patients.

According to I.V. Aldushina, on the 7th day after myocardial infarction, most patients are characterized by anxiety, fear, physical and mental asthenia, and a pessimistic assessment of the present and future. The severity of such symptoms depends on the severity class of myocardial infarction and the nature of the patient’s personality. A psychological study during this period in patients with severity classes 3-4 reveals an increase in scales of depression, schizophrenia, and, to a lesser extent, hypochondria. In patients who have previously suffered a myocardial infarction, prolonged attacks of angina pectoris and severe hypertensive crises, the subacute period is characterized by particular anxiety and a more pronounced rise in the hypochondria scale with a moderate increase in the depression and schizophrenia scales. The “mania” scale occupies a minimal position in the profile.

V.P. Zaitsev divides the personal reactions of patients who have suffered a myocardial infarction into adequate and pathological. With adequate psychological reactions, patients comply with the regime and fulfill all the doctor’s instructions, the patients’ behavior corresponds to the given situation. Depending on the psychological characteristics of patients, one can distinguish decreased, average and increased adequate reactions.

With a reduced reaction, patients outwardly give the impression of being insufficiently critical of the disease. They have an even, calm or even good mood. They tend to assess the prospect favorably, overestimate their physical capabilities, and downplay dangers. However, upon deeper analysis, it was discovered that patients correctly assessed their condition, understood what happened to them, and knew about the possible consequences of the disease. They only push away gloomy thoughts and try to “turn a blind eye” to the changes caused by the disease. Such a partial “denial” of the disease. Apparently, it should be regarded as a kind of defensive psychological reaction.

With an average reaction, patients have a reasonable attitude towards the disease, correctly assess their condition and prospects, and realize the seriousness of their situation. They trust the doctor and follow all his instructions.

With an increased reaction, the patient’s thoughts and attention are focused on the disease. The background mood is somewhat reduced. The patient tends to be pessimistic about the prospects. He catches every word the doctor says about the disease. He is careful, partially monitoring his pulse. Strictly follows doctor's instructions. The patient's behavior is changed, but not impaired. As with other types of adequate reactions, it corresponds to the given situation.

Pathological reactions can be divided into cardiophobic, anxiety-depressive, hypochondriacal, hysterical and anosognosic.

With a cardiophobic reaction, patients experience constant fear “for the heart,” fear of repeated heart attacks, and sudden death from a heart attack. Fears appear or sharply intensify during physical stress, when leaving the hospital or home. The further from the point where the patient, in his opinion, can receive proper medical care, the stronger the fear. Excessive caution appears, even with minimal physical activity.

The depressive reaction is characterized by a depressed, depressed mood, apathy, hopelessness, pessimism, disbelief in the possibility of a favorable course of the disease, and a tendency to see everything in a gloomy light.

The patient answers questions in monosyllables, in a quiet voice. Facial expressions express sadness. Speech and movements are slow. The patient cannot hold back tears when talking about topics that concern him about health, family, and prospects for returning to work. The presence of anxiety in the mental status is characterized by internal tension, apprehension of impending disaster, irritability, restlessness, excitement, fears for the outcome of the disease, anxiety for the well-being of the family, fear of disability, anxiety about things left at work. Sleep is disturbed. The patient asks to be prescribed sedatives, repeatedly asks questions about his state of health and life prognosis, morbidity and ability to work, wanting to receive a reassuring answer and assurances that his life is not in danger.

The hypochondriacal reaction is characterized by unjustified concern for one’s health, many complaints about various unpleasant sensations and pains in the heart and other parts of the body, a clear overestimation of the severity of one’s condition, a pronounced discrepancy between the number of complaints and the insignificance or absence of objective somatic changes, excessive fixation of attention on the condition your health. The patient constantly monitors the functions of his body and often seeks advice from other specialists.

With a hysterical reaction, patients are emotionally labile, self-centered, demonstrative, striving to attract the attention of others and arouse sympathy. The facial expressions of such patients are lively, their movements are expressive, and their speech is emotionally rich. Autonomic hysteroform disorders are observed.

With an anosognosic reaction, patients deny the disease, ignore treatment recommendations, and grossly violate the regimen.

At the same time, a close relationship was revealed between the nature of mental reactions to the disease and the premorbid personality structure. Thus, people who have always been characterized by anxiety, suspiciousness, and rigidity react to a heart attack with a cardiophobic or hypochondriacal reaction. People who, even before illness, tend to react to life’s difficulties with despair, depressed mood, a pessimistic assessment of the situation, and respond to myocardial infarction with a depressive reaction. In individuals with hysterical character traits, in response to myocardial infarction, a hysterical or anosognosic reaction is most often observed.

In addition to emotional and personal changes, patients with coronary artery disease also experience a decrease in mental performance. In most cases, dynamic disturbances of cognitive processes are detected. Sometimes patients note that they can no longer follow the pace of films being shown and have great difficulty in perceiving the fast pace of speech. Such patients require conditions of slow perception to adequately process new material.

In mental production, most often, the generalization process is not disrupted, but when a large number of features are combined, a sharp slowdown in orientation in a new task can be observed. On familiar material, the orientation is sufficient and an adequate method of action is maintained.

The most characteristic sign of changes in cognitive processes in IHD can be considered difficulties in simultaneously covering several elements of the situation, which is a consequence of a narrowing of the scope of perception. The main difficulty in this case is the operation of combining several features. This is clearly visible when performing the alignment test. In healthy people, the relative increase in difficulty does not cause any difficulties, and no sharp differences are observed either in terms of accuracy or in terms of tempo when performing the entire series of tests. For patients with a narrowed scope of perception, it is characteristic that when performing elementary tasks, the pace differs little from the norm. As tasks become more complex, where it is necessary to combine several characteristics, the pace slows down sharply and the number of errors increases. Due to the impossibility of quickly covering the entire complex of conditions that play a role in a situation, it is necessary to move from simultaneous perception to slow sequential one.

Almost all patients with coronary artery disease experience a weakening of concentration and retention of attention, more or less pronounced signs of difficulty in distributing and switching attention from one sign to another. Signs of exhaustion of mental processes are often revealed.

Typically, patients complain of forgetfulness and memory loss. Research shows that these complaints are also based on a narrowing of the scope of perception. Due to the narrowed scope of perception, patients, when learning 10 words for the first time, have time to remember only the first few words of the series. When repeating, patients try to fix their attention on previously missed words and forget those that were spoken for the first time. The accumulation of memorized material begins with the third or fourth listening. Memorization productivity is reduced due to the difficulty of covering and fixing many elements of a verbal series.

Have you ever gotten sick before an important event (report, speech, etc.)? Do you get sick more often than you would like or suffer from chronic diseases?

Do your relatives have chronic illnesses and are you worried that something similar could happen to you?

Then it's time for a heart-to-heart conversation... with your body. The body begins to talk to us in the language of illness when it cannot reach us in any other way. Where do you think it goes because you didn’t respond to the minibus lady who stepped on your foot, or didn’t object to the boss? Where do those feelings disappear that you experience when you again agree to help out a friend, despite the fact that you had other plans, or when you force yourself to go to a job you don’t like again and again every morning?

It is our body that suffers from all the feelings, emotions, and unrecognized needs that we have not expressed. Pay attention to your speech, how many physical metaphors there are in it, often indicating the place of the disorder (“I’m sick of...”, “I feel like a squeezed lemon,” “If only my eyes could not see...”, “a stone on my heart,” “lump in the throat”, “reluctantly”, “...to the point of gnashing of teeth” and the like). This is how we often characterize the feelings and emotions that we experience. And our body has no choice but to take it all personally, since we do not know how to recognize in a timely manner and do not find ways to express externally what we experience.

And then the question arises, what does our body want to tell us with this or that disease, what do we get when we fall into illness? Maybe care that is so lacking, or time for yourself, or the opportunity not to overcome yourself again? And most importantly, what do you need to stop or start doing to be healthy? Although you can often encounter such a psychological paradox that being healthy is more difficult than being sick, because a healthy person is not only fulfilled and successful, but also bears great responsibility, which not everyone is ready for.

The state of the body is largely a reflection of a person’s mental processes. The disease can be a consequence of psychological trauma, conflicts, and repressed experiences. Psychosomatics (Greek psyche – soul, soma – body)– a direction in medicine and psychology that studies the influence of psychological factors on the occurrence and development of somatic diseases.

The basis of psychosomatic illness is a reaction to emotional experience, accompanied by pathological disorders in organs. Many diseases (arterial hypertension and other diseases of the cardiovascular system, bronchial asthma and chronic bronchitis, gastritis and peptic ulcers, diseases of the endocrine system, eczema and neurodermatitis, gynecological, urological, and oncological diseases) can be caused by psychological reasons.

How does this happen? Nature has established that at the moment of mental stress, processes occur in the human body that help overcome a stressful situation. How do more primitive creatures react to stress? There are three possible reactions: “freeze”, “hit”, “run”. Our body reacts in the same way: rapid heartbeat, increased blood pressure (when fleeing or fighting), or vice versa - a decrease in pulse rate and pressure (freezing), the work of the digestive system slows down or, on the contrary, peristalsis increases, hormone production increases or decreases, activation occurs immune system, and other processes aimed at survival in situations of stress. But this state of the body is designed for a short time, only to overcome the danger. When you are in a stressful situation for a long time, there is an increased consumption of energy, hormones, and so on.

If the stressful state is not realized in a behavioral reaction and is not resolved, the formation of diseases occurs. So, for example, a dog, when angry, can bite, and when frightened, it can run away, that is, a behavioral reaction occurs that is adequate to the stimulus. Have you often, in response to a complaint addressed to you by, well, management, expressed in a boorish manner, responded in kind, or used your fists? Or, feeling afraid of your mother, mother-in-law, boss, etc., did you turn around and run away? It’s unlikely, we are social creatures and therefore often do not show fear, restrain irritation, and thereby do not realize the body’s readiness to react to a stress factor.

It’s easier for people who easily express their emotions and satisfy their needs; their risk of falling ill is significantly lower. Illness is the flip side of willpower and self-control. If a person experiences strong feelings and emotions, but restrains their expression, he does not implement stress reactions, which leads to depletion of the body's systems and, as a result, illness.

If visits to doctors do not bring significant relief from suffering, you may need qualified psychological help in addition to medical treatment. As a rule, the more severe the disease, the more persistent the symptom (it does not respond well to traditional treatment), the more frequent the disease relapses, the more important it is to undergo a course of psychotherapy.

How can a psychologist help in this situation? To figure out with you why the manifestations of the disease are needed in your life, what or who they are dedicated to, what need or unexpressed feelings the disease hides. How can you, while remaining a social person, learn to talk about your needs and express your feelings towards the person to whom they are addressed, and not accumulate them in your own body. This will help you hear the “voice” of your body and agree with it on how you will take care of yourself and build harmonious relationships with yourself and with the world around you, how you will choose life goals that exceed the disease and deprive it of secondary benefit. As you clarify the hidden psychological causes of your illnesses, with the help of a specialist you will be able to find your and only your resources in order to live without illness or get along with the illness, which will allow you to become the master of your health and will help improve the quality of life.

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It is important to know that the presented psychosomatosis is not always preceded by cardioneurosis. Often, the patient is so carried away by the collisions of life that everything that happens to him is perceived as a normal working life; and psychological conflicts, meanwhile, take place in the unconscious sphere. For example, young men who lead an absolutely healthy lifestyle get sick with acute myocardial infarction in a similar way.

Psychodynamics hypertensive illnesses. In a “hypergenic” family, the parents actively impose their will on the child through negative verbal communication. Family relationships are characterized by many prohibitions, restraining child activity. A harsh type of upbringing with a lack of tenderness is noted. In relation to each other, parents are cold-blooded, hide their feelings from the child - a substrate arises for inhibited anger in adulthood. Education of the “delegation” or “binding” type predominates. If in such a family one of the parents (usually the mother) is highly anxious and emotionally labile, then excessive sensitivity is passed on to the child; he may perceive the situation as “rejection” - a substrate for adulthood arises.

There are 2 types of psychodynamic behavior that predispose to hypertension.

A combination of the high pace of life in the city with the need to complete the maximum number of tasks per unit of time, suppressed aggression (anger), mistrust to maintain social ties (“ inhibited anger") and low mood. Characteristic of active, business people.

Briefly: “Increased demands, restrained anger, mistrust.”

Combination alarming hyper-responsibility, excessive emotional excitability and sleep disturbances. It is more common in middle and especially older age groups.

Briefly: "Frustration, fear, embarrassment."

Psychodynamics IHD . In a “cardiogenic” family, relationships between parents are often characterized by a conflict of dominance. Despite attempts to rule, the father is not an authority in the family. On the part of an emotionally restrained mother, control prevails in relation to the child; parenting strategy - “delegation”. Excessive control on the part of the mother leaves a “narcissistic imprint” on the child’s character. Therefore, in adult life, grievances will be perceived by him as grossly narcissistic (“close to the heart”).

There are 2 types of psychodynamic behavior that predisposes to IHD.

Key principle ( super valuable) experiences. Often (but not always!) Characteristic of persons with high social activity, endowed with narcissistic qualities, tuned to competition, the maximum volume of achievements combined with wariness and distrust of others ( Type A personality). Competition is based on opposition myself. Possible options for the key experience: accusations of insolvency (or underestimation) of professional achievements, inability to fulfill assumed obligations, threat to business reputation, inevitability of separation (loss) and anything else that is “extremely important” for a particular person. A negative resolution of a key experience is perceived as gross narcissistic resentment with an emotionally depressive overtones.

Briefly: “Increased demands, ambition, narcissism.”

Anxious hostility based on principle conversions (Type D personality). A combination of anxious-depressive character, suppression of negative emotions (“emotional closedness”), low social support and, often, “existential vacuum” (unconscious lack of meaning in life). It is more common among people with low social status and in elderly subjects. In general, such a pattern of behavior predisposes to atherosclerosis of any location.

Briefly: “Disappointment, pessimism, suppression of emotions.”

Both psychodynamic patterns of behavior are characterized by mistrust to others. During a highly valuable experience, the personality is, as a rule, extroversive; during conversion, it is introversive.

The role of the “nervous factor” in the origin of coronary atherosclerosis by B. Pasternak in the novel “Doctor Zhivago” is interestingly described in the words of the main character:"In our time, microscopic forms of cardiac hemorrhages have become very frequent. They are not all fatal... This is a disease of modern times. I think its reasons are of a moral order. The vast majority of us are required to constantly, in a system of crookedness. It is impossible without consequences for health every day every day to express yourself is contrary to what you feel; to crucify yourself in front of what you don’t like, to rejoice at what brings you misfortune. Our nervous system is not an empty phrase, not an invention... It cannot be endlessly raped with impunity."

Psychodynamics arrhythmias hearts. There are 2 types of psychodynamic behavior that predispose to cardiac arrhythmias.

Difficulty expressing emotions, both negative and positive, accompanied by a fear of losing emotional control. Type of education: rejection or tying.

Briefly: “Fear of activity and initiative.”

A hectic life in pursuit of money, material well-being combined with narcissistic anger. Often combined with hypertension. Type of education: delegation.

Briefly: "Increased demands combined with angry verbalization."

Differences between somatopsychosis and cardioneurosis: severe hypochondria, subordinating a significant part of the patient’s life to concentration on painful sensations; complete or partial disability; reduction of self-criticism; pretentious, metaphorical descriptions of unpleasant (painful) sensations spreading beyond one anatomical area (for example, a “burning” in the heart area, radiating “rays” to the abdominal area); positive therapeutic effect from long-term, multicomponent psychotropic therapy. In fact, cardiogenic somatopsychosis is the same cardioneurosis, only with more painful symptoms, elements of decreased criticism and the beginning of social maladjustment.

Risk factors development of somatopsychosis: low level of social support; previous severe somatic illness (for example, stroke or heart attack), aggravating neurosis; rapid loss of high social status (for example, retirement of a high-ranking individual); old age. Patients suffering from somatopsychosis are often hospitalized in somatic hospitals with “acute abdomen”, “suspicion of myocardial infarction”, “exacerbation of osteochondrosis”, etc. That is, somatopsychosis mimics a severe somatic disease; the patient himself is convinced of its presence. Correct diagnosis of somatopsychosis is based on the discrepancy between the patient’s complaints and some somatic disease (“multiple complaints syndrome”) in combination with “disabling” hypochondria. Ideally, such patients should be treated by a psychiatrist. In reality, internists are the first to encounter patients suffering from somatopsychosis: cardiologists, neurologists, surgeons, etc. With somatopsychosis, the core of personality is preserved, so such patients find themselves out of sight of psychiatrists for a long time. Difficult to treat are those patients whose symptoms of somatopsychosis are combined with symptoms of a chronic somatic disease (for example, angina pectoris). In this case, it can be extremely difficult to differentiate dangerous sensations (for example, angina pectoris) from non-dangerous ones (for example, neurotic cardialgia).

The final stage of cardioneurotic syndrome is progressive somatopsychosis (hypochondriacal delusional psychosis). The fundamental difference from the previous stage is thatthat a patient with progressive somatopsychosis is convinced that his symptoms are “projected from the outside.” In other words, something external will be to blame for the bodily sensations (“at night my wife beats me, after which my heart breaks all day”). The core of the personality is destroyed; the new personality, due to delusional symptoms, is patronized by a psychiatrist.

Neurotic personality disorder, like any somatic disease, requires close attention from a doctor. The lack of timely, correct diagnosis and treatment can lead to severe, disabling consequences for the patient, when a harmless, functional cardioneurotic disease turns into a psychotic “idée fixe.”