Psychophysiologic Disorders (PPD)

By Suzi, Integrated Diploma in Resilience and Wellness Coaching Skills

 

Mainstream Western medicine has largely ignored the role of the mind-body connection in health, pain and illness. However, recent research shows certain conditions can actually be attributed to it. These conditions have been termed Psychophysiologic Disorders or Mindbody Syndrome, in which the role of emotions, personality traits and learned neural pathways in the brain cause the physical symptoms experienced. By focusing on the diagnosis and treatment of these conditions, the mind-body connection is demonstrated.

The field of Psychoneuroimmunology overtly establishes the mind-body connection, confounding the view that the mind and body are separate entities. The mind, endocrine, nervous and immune systems have been found to be in continuous chemical communication with one another which ultimately affects our biology (Maier et al, 1994)^[1]. As such, our thoughts, feelings, beliefs and hopes (our minds) are changing our biology (our body) through simple chemical and electrical activity in the nerve cells of our brains (Ray, 2004)^[2]. This finding has allowed clinicians and researchers alike to begin understanding some illnesses in a very different way.

Chronic pain and other chronic symptoms, like chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia, are now being understood from the point of view of the mind-body connection (Clarke et al, 2019)^[3]. Mainstream medicine tends to dismiss these conditions, largely because extensive diagnostic tests fail to show any abnormalities and so their prognosis is that the condition must be managed and can never be cured, a reality I have experienced firsthand.

However, a section of healthcare professionals are now diagnosing and treating these ‘unexplainable’ conditions and providing evidence for their therapeutic outcomes through research. These conditions have been termed Psychophysiologic Disorders (PPD) – combining ‘psyche’ (meaning mind or soul) and ‘physiology’. They consist of pain or other physical symptoms that affect almost any part of the body with symptoms being, ‘caused or amplified by psychological processes’ (Clarke & Shubiner, 2019)^[4]. Emotional processes such as the long-term impact of adverse childhood experience, current life stresses, limited self-care skills and suppressed emotions.

Research by Candace Pert (1985)^[5] showed the presence of neuropeptides and their receptors on the cell walls of the brain and immune system indicating the link between emotions and health. As Pert (1999)^[6] stated, ‘the chemicals that are running our body and our brain are the same chemicals that are involved in emotion,’ and it is the subconscious brain and the way it responds to emotions that is the driving force behind psychophysiologic reactions (Schubiner & Kleckner, 2019)^[7].

When the brain experiences emotions, they are stored as emotional memories in a network of the brain which includes the amygdala and anterior cingulate cortex (Schubiner, 2016). These structures are closely connected to the hypothalamus, the center for the autonomic nervous system (ANS), which, when in times of stress, is activated to produce stress hormones, such as cortisol and adrenaline, and the ‘fight or flight’ stress response is turned on. This ANS activation can cause many symptoms, like pain, numbness or palpitations, as the nervous or cardiovascular systems are subsequently activated (Schubiner, 2016), a connection indicated by Psychoneuroimmunology. This pain is then activated through learned neural pathways in the brain (Shubiner, 2016)^[8] in response to a situation the brain perceives as dangerous. Ultimately, emotional events are causing physical events in the body.

In PPD, this subconscious emotional element initially gives rise to symptoms. Emotional experiences learnt or suppressed from childhood that are imprinted in the brain can trigger an ANS reaction as an adult when we go through a similar experience that triggers the same childhood fear, anger or guilt. Our subconscious mind tries to alert us to a problem to protect us and communicates this through pain and symptoms (Schubiner 2016)^[9]. Looking at child abuse as an extreme example of an emotional experience, many studies show an association between history of child abuse and adult chronic pain (Davis et al, 2005^[10]; Sachs-Ericsson et al, 2017^[11]).

Anger is a key emotion that causes physical symptoms. John Sarno (1998)^[12], upon whose theories PPD are based, believed it was the repression of rage in the subconscious that is responsible for Mindbody Disorders. Recent research has actually shown that the suppression of anger affects people’s experience of pain, indicating the mind-body connection. For example, Burns et al (2008)^[13] conducted a study where patients with low back pain were told to either suppress or not suppress anger during a stressful laboratory experiment. Those instructed to suppress emotions reported more pain, both during and after the experiment.

Gabor Mate´, a clinical physician and expert on addiction, noted from his own practice that many chronic diseases he saw were characterised by emotional life patterns, such as the chronic repression of anger (Mate´, 2015)^[14]. He also notes characteristics of being overly responsible, placing others’ emotional needs before one’s own and the core belief that one is responsible for how other people feel.

It is these personality traits and more that have been identified as playing a key role in PPD, another indication of the mind-body connection. Goodism, perfectionism, low self-esteem, high personal expectations, needing to be liked, being overly self-critical, overly conscientious and not standing up for yourself can all create inner conflict and turmoil, giving rise to negative emotions which contribute to the symptoms of PPD (Sarno, 1998^[15]; Oldfield, 2015^[16]; Schubiner, 2016^[17]). Research has found self-esteem and perfectionism to be indicated in chronic fatigue syndrome (Kempke et al, 2011a^[18];2011b^[19]) and fibromyalgia (Pinto et al, 2016^[20]) for example.

Perhaps the most notable indication of the mind-body connection comes from PPD treatments. In chronic conditions perceived to be incurable by mainstream medicine, it is quite astounding that mind-body treatments are curing people completely of their symptoms. On the one hand, treatments deal with current stresses, emotions and trauma, and on the other, address the fear and worry that keeps the pain or symptoms conditioned in the brain, both with the result of calming down the overactivated ANS (Oldfield, 2015)^[21].

Journaling, or expressive writing, to uncover repressed emotions and hidden stresses is one aspect of treatment and has been found in many studies to effect an improvement in immune function and physical health (Pennebaker & Chung, 2007)^[22] as well as influence the ANS (Pennebaker, Hughes & O’Heeron, 1987)^[23]. In fibromyalgia patients, Lumley et al (2017)^[24] compared Emotional Awareness and Expression Therapy as an intervention against fibromyalgia education and cognitive-behavioural therapy (CBT) and found it to be more effective.

Mindfulness is another element of PPD treatment that signifies the mind-body connection. Practicing mindfulness enables the patient to break the fear-pain cycle that contributes to symptoms through awareness and reframing of fear-based thoughts, which allows the danger-alarm mechanism in the brain to turn off (Talks at Google, 2018)^[25]. Mindfulness-based stress reduction programmes have been found to help with chronic pain in fibromyalgia patients by affecting ANS responses. For example, Lush et al (2009)^[26] found that women with fibromyalgia who completed these programmes had decreased basal sympathetic tone.

There is much more to be said to understand PPD but even this preliminary exploration clearly establishes the mind-body connection. As someone who has experienced a PPD firsthand, I am both grateful for and fascinated that this is now being recognised by a wider body of medicine. Clearly, more research and understanding is needed until both patients and mainstream medicine alike can accept these sorts of mind-body diagnoses.

 

REFERENCES

•  Burns, J. W., Quartana, P., Gilliam, W., Gray, E., Matsuura, J., Nappi, C., Wolfe, B., & Lofland, K. (2008). Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: evaluation of an ironic process model. Health Psychology. 27(5), 645-652.
• Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment. Psychophysiologic Disorders Association.
• Clarke, D., & Schubiner, H. (2019). Introduction. In Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment (pp. 4-5). Psychophysiologic Disorders Association.
• Davis, D., Luecken, L., Zautra, A. (2005). Are Reports of Childhood Abuse Related to the Experience of Chronic Pain in Adulthood? Clinical Journal of Pain. 21(5), 398-405. doi: 10.1097/01.ajp.0000149795.08746.31.
• Kempke, S., Luyten, P., Van Houdenhove, B., Goossens, L., Bekaert, P., & Van Wambeke, P. (2011a). Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome. Clinical rheumatology, 30(12), 1543–1548.
• Kempke, S., Van Houdenhove, B., Luyten, P., Goossens, L., Bekaert, P., & Van Wambeke, P. (2011b). Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism?. Psychiatry research, 186(2-3), 373–377.
• Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain, 158(12), 2354–2363.
• Lush, E., Salmon, P., Floyd, A., Studts, J. L., Weissbecker, I., & Sephton, S. E. (2009) Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates. J Clin Psychol Med Settings, 16(2), 200–207. doi: 10.1007/s10880-009-9153-z.
• Maier, S. F., Watkins, L. R., & Fleshner, M. (1994). The interface between behavior, brain, and immunity. American Psychologist, 49, 1004–1017.
• Maté, G. (2015, November 16). Gabor Maté: How to Build a Culture of Good Health. Yes Magazine.
• Oldfield, G. (2015). Chronic Pain: Your key to recovery. 2nd ed. 2QT Limited Publishing.
• Pennebaker, J. W., Hughes, C. F., & O’Heeron, R. C. (1987). The psychophysiology of confession: Linking inhibitory and psychosomatic processes. Journal of Personality & Social Psychology, 52, 781-793.
• Pennebaker, J. W., & Chung, C. K. (2007). Expressive Writing, Emotional Upheavals, and Health. In H. S. Friedman & R. C. Silver (Eds.), Foundations of health psychology (pp. 263–284). Oxford University Press.
• Pert, C., Ruff, M., Weber, R., & Herkenham, M. (1985). Neuropeptides and their receptors: A Psychosomatic network. The Journal of Immunology 135(2), 820-826.
• Pert, C. (1999). Molecules of Emotion: Why You Feel The Way You Feel. Pocket Books.
• Pinto, A., Pereira, A., Costa, C., Marques, M., da Silva, J., & Macedo, A. (2016). Perfectionism in Chronic Pain: Are There Differences between Fibromyalgia, Rheumatoid Arthritis and Healthy Controls? Annals of the Rheumatic Diseases, 75(2), 1190.
• Ray, O. (2004). How The Mind Hurts And Heals The Body. American Psychologist, 59(1), 29-40.
• Sachs-Ericsson, N. J., Sheffler, J. L., Stanley, I. H., Piazza, J. R., & Preacher, K. J. (2017). When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders. Journal of clinical psychology, 73(10), 1403–1428.
• Sarno, E. J. (1998). The Mindbody Prescription. Healing The Body, Healing The Pain. Hachette Book Group.
• Schubiner, H. (2016). Unlearn Your Pain. A 28 Day Process To Reprogram Your Brain. 3rd ed. Mind Body Publishing.
• Schubiner, H., & Kleckner, I. (2019). The Neurophysiology and Psychology of Pain in Psychophysiologic Disorders. In Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment (p. 49). Psychophysiologic Disorders Association.
• Talks at Google. (2018, January 11.) Breakthrough with Healing Chronic Pain | Howard Schubner [Video]. YouTube.

^[1] Maier, S. F., Watkins, L. R., & Fleshner, M. (1994). The interface between behavior, brain, and immunity. American Psychologist, 49, 1004–1017.

^[2] Ray, O. (2004). How The Mind Hurts And Heals The Body. American Psychologist, 59(1), 29-40.

^[3] Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment. Independent Publisher.

^[4] Clarke, D., & Schubiner, H. (2019). Introduction. In Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment (pp. 4-5). Psychophysiologic Disorders Association.

^[5] Pert, C., Ruff, M., Weber, R., & Herkenham, M. Neuropeptides and their receptors: A Psychosomatic network. The Journal of Immunology 135(2), 820-826.

^[6] Pert, C. (1999). Molecules of Emotion: Why You Feel The Way You Feel. Pocket Books.

^[7] Schubiner, H., & Kleckner, I. (2019). The Neurophysiology and Psychology of Pain in Psychophysiologic Disorders. In Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment (p. 49). Psychophysiologic Disorders Association.

^[8] Schubiner, H. (2016). Unlearn Your Pain. A 28 Day Process To Reprogram Your Brain. 3rd ed. Mind Body Publishing.

^[9] Schubiner, H. (2016). Unlearn Your Pain. A 28 Day Process To Reprogram Your Brain. 3rd ed. Mind Body Publishing.

^[10] Davis, D., Luecken, L., Zautra, A. (2005). Are Reports of Childhood Abuse Related to the Experience of Chronic Pain in Adulthood? Clinical Journal of Pain. 21(5), 398-405.

^[11] Sachs-Ericsson, N. J., Sheffler, J. L., Stanley, I. H., Piazza, J. R., & Preacher, K. J. (2017). When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders. Journal of clinical psychology, 73(10), 1403–1428.

^[12] Sarno, E. J. (1998). The Mindbody Prescription. Healing The Body, Healing The Pain. Hachette Book Group.

^[13] Burns, J. W., Quartana, P., Gilliam, W., Gray, E., Matsuura, J., Nappi, C., Wolfe, B., & Lofland, K. (2008). Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: evaluation of an ironic process model. Health Psychology. 27(5), 645-652.

^[14] Maté, G. (2015, November 16). Gabor Maté: How to Build a Culture of Good Health. Yes Magazine.

^[15] Sarno, E. J. (1998). The Mindbody Prescription. Healing The Body, Healing The Pain. Hachette Book Group.

^[16] Oldfield, G. (2015). Chronic Pain: Your key to recovery. 2nd ed. 2QT Limited Publishing.

^[17] Schubiner, H. (2016). Unlearn Your Pain. A 28 Day Process To Reprogram Your Brain. 3rd ed. Mind Body Publishing.

^[18] Kempke, S., Luyten, P., Van Houdenhove, B., Goossens, L., Bekaert, P., & Van Wambeke, P. (2011a). Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome. Clinical rheumatology, 30(12), 1543–1548.

^[19] Kempke, S., Van Houdenhove, B., Luyten, P., Goossens, L., Bekaert, P., & Van Wambeke, P. (2011b). Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism?. Psychiatry research, 186(2-3), 373–377.

^[20] Pinto, A., Pereira, A., Costa, C., Marques, M., da Silva, J., & Macedo, A. (2016). Perfectionism in Chronic Pain: Are There Differences between Fibromyalgia, Rheumatoid Arthritis and Healthy Controls? Annals of the Rheumatic Diseases, 75(2), 1190.

^[21] Oldfield, G. (2015). Chronic Pain: Your key to recovery. 2nd ed. 2QT Limited Publishing.

^[22] Pennebaker, J. W., & Chung, C. K. (2007). Expressive Writing, Emotional Upheavals, and Health. In H. S. Friedman & R. C. Silver (Eds.), Foundations of health psychology (pp. 263–284). Oxford University Press.

^[23] Pennebaker, J. W., Hughes, C. F., & O’Heeron, R. C. (1987). The psychophysiology of confession: Linking inhibitory and psychosomatic processes. Journal of Personality & Social Psychology, 52, 781-793.

^[24] Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain, 158(12), 2354–2363.

^[25] Talks at Google. (2018, January 11.) Breakthrough with Healing Chronic Pain | Howard Schubner [Video]. YouTube.

^[26] Lush, E., Salmon, P., Floyd, A., Studts, J. L., Weissbecker, I., & Sephton, S. E. (2009) Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates. J Clin Psychol Med Settings, 16(2), 200–207.

 

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