Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.85 DHR Proceedings ǀ http://dhrproceedings.org 24 2023, Vol. 2 No. S2 24-27 COMMENTARY Psychosomatic Disorder in Women with Exposure to Violence or Stress Abigail Alejandro1,2 Grecia Benavidez1,2 Ailee Cruz11,3 Juan Garcia1,4 Mia Garza1,4 Victoria Garza1,4 Catherin Guerra1,4 Christin Hernandez1,3 Fatima Montes1,4 Jocelyn Olvera1,3 Lanika Reyna1,4 Graciela Vela1,4 1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health Institute for Research and Development 2 Los Fresnos High School 3 Pharr-San Juan-Alamo Independent School District 4 La Grulla High School Received: June 29, 2023 Accepted for publication: August 25, 2023 Published: November 15, 2023 Introduction Have you ever had a weird symptom and immediately jumped to conclusions about a severe illness you might have? Maybe you had a bug bite near your armpit and thought it was cancer. Or perhaps, during the pandemic, swore you had symptoms of COVID-19 if there was an encountered or exposure to someone that had contracted the virus. These constant, abnormal, thoughts are one of the many factors of a mental illness defined as psychosomatic disorder. Psychosomatic disorder is one of the most difficult disorders to diagnose in patients because it is often associated without any medical explanation. It is most common in women who have gone through trauma, stress, abuse, or violence.1 Psychosomatic disorder is a psychological state characterized by the manifestation of physical symptoms in a person that is difficult to be medically explained and diagnosed.2 A person with psychosomatic disorder may overthink and cause these anomalies to become far worse than they are. People may dwell on the symptoms of an illness and eventually make themselves feel or become sick. Although anyone may experience psychosomatic disorder at any point in their lives, it is more probable in women who have undergone a violent act, addiction, neglect, loss, abuse, or any traumatic event such as COVID-19.3 Definition What exactly is psychosomatic disorder? The word psycho is associated with mental disorders and somatic is related to conditions of the body.2 Therefore, psychosomatic disorder, in scientific definition, is a condition where the patient believes they are suffering from a medical condition; however, there is no clear medical cause.2 Consequently, patients gain plenty of anxiety and paranoia stuck on the thought that there could be an underlying medical issue they are experiencing. This can lead to many emotions such as frustration and fear. Eventually, physical and mental factors take a strenuous toll on women with the disorder, and it manifests through many symptoms. Fatigue, insomnia, aches/pains throughout the body, hypertension, trouble breathing, ulcers, indigestion, and headaches are some of the deteriorating symptoms accompanied by the disorder.2 These physical symptoms add to the distress, feeding into the belief that something is wrong with them. In regards to its history, it was originally waved as hysteria. Therefore, the discovery and diagnosis of psychosomatic disorder was delayed. Even now, women are portrayed as “dramatic” and “fragile”.3 Currently, scientists and doctors still have not come up with a conclusion as to why it occurs. People struggle physically due to stress, hormones, and chemical build-up. Women, especially those who Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.85 DHR Proceedings ǀ http://dhrproceedings.org 25 2023, Vol. 2 No. S2 24-27 have experienced violence or abuse, are significantly more prone to being diagnosed with psychosomatic disorder.3 Symptoms Psychological Symptoms Women who have a history of previous mental or physical abuse are more susceptible to experiencing terminal effects on their health.4 Over a period of three years, women who were older, black, and/or divorced appeared to become more vulnerable than others in experiencing psychosomatic disorder symptoms.4 Some examples of the mental symptoms the disorder causes are hallucinations, paranoia, anxiety, depression, and suicidal tendencies.4 In the years 1968 through 1980, adults 30 to 80 years old were given a self-administered questionnaire asking about their prevalence of psychosomatic symptoms.4 Many of the symptoms were physical, but the majority were stress-related mental health issues. Patients also indicated a sense of frustration by the lack of proper diagnosing procedures.4 Many women are not believed or heard when they speak out on the existing symptoms they have been experiencing, so they become ill and depressed. The experience they had with health professionals along with the pre-existing anxiety and paranoia can lead a patient to suicidal and life-threatening situations. Physical Symptoms As mentioned earlier, there are many symptoms that come with psychosomatic disorder, most of which are psychological. However, some physical symptoms can cause discomfort to a patient. Female patients with psychosomatic disorders tend to experience very high levels of stress. Thus, they undergo physical effects such as abdominal symptoms (constipation, diarrhea, or other abdominal pain), headache/migraine, hypertension, fatigue, insomnia, and musculoskeletal symptoms; all of which deteriorate a patient's health status.4 Many of these physical effects can progress into more serious underlying disorders such as personality disorders.2 Mental disorders can greatly impact physical health and can contribute to the progression of psychosomatic disorders and deterioration of overall health. Mental Health Effects on Women Women are more predisposed to developing stress-related disorders such as anxiety and depression. Findings from the 2020 Health Survey of Catalonia demonstrate that the percentage of women with psychosomatic disorders was 24.2% higher than men.5 Further studies determined that the increase in prevalence in women may be correlated to higher rates of women who experience physical, emotional, and/or sexual abuse, hindering their mental health. The violence against women results in the vulnerability of women’s mental and physical health leading to possible trauma-related psychosomatic symptoms.6 Women who have experienced physical and sexual abuse may develop PTSD, depression, anxiety, and other linked disorders. With the torment on their mental state, women begin to face psychosocial effects that contribute to somatic symptoms. The mental health of women is determined by the expression of psychosomatic symptoms based on self-questionnaires that ask for a specific set of symptoms. However, correlating symptoms such as anxiety, depression, and mood swings to somatic symptoms can result in the manipulation of a woman’s understanding of her own health. When reliving psychological trauma, women show an increase in psychosomatic symptoms such as lack of sleep, depressive periods, anxiety and trauma-related anxiety.2 The repression of thoughts and emotions actually increases somatic symptoms and the deterioration of physical health. Moreover, women can also experience fear when revealing the traumatic events due to women being stigmatized as “dramatic” or too “sensitive”.7 Therefore, women with psychosomatic disorders tend to be overlooked, causing symptoms to progress without treatment. Such frustrations develop further stress on the psychological aspect of the psychosomatic disorder, creating a cycle of worsening symptoms.8 Causes and Prevention Causes Although there are no particular causes of the disorder, several factors can contribute to it.4 For example, substance abuse, violence, anxiety, and depression can all be factors that eventually trigger psychosomatic disorders.4 Women who have high stress levels and are constantly in a state of panic are more susceptible to the disorder. Additionally, smoking and substance abuse are some of the many detrimental ways that women try to relieve the stress Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.85 DHR Proceedings ǀ http://dhrproceedings.org 26 2023, Vol. 2 No. S2 24-27 of psychosomatic disorder.4 This can trigger even more symptoms of the disorder. Prevention If a patient exhibits early indicators of the disorder or any of the contributing factors, it is important to be self-aware. Having an open mind to possibilities and being accepting of an issue can prevent a world of problems. Getting regular checkups with doctors is a vital part of preventing and treating the disorder. Seeking aid such as therapy for previous trauma can be an effective way of preventing symptoms and even contraction of the disorder. Specialists Since patients with psychosomatic disorders have so many concerns about their health, it is hard to pinpoint just one specialist they consult with. Physicians, therapists, and general doctors are some of the examples of specialists they visit often. However, psychiatrists, specifically liaison psychiatrists, are medical doctors who specialize in diagnosing, treating, and caring for patients with psychosomatic disorders.9 Liaison psychiatry is a sub-specialty that specifies the physical and psychological components of a patient.9 It takes a lot of hard work and dedication to be successful in this profession, so it is clear that these doctors are well educated and equipped to treat patients with the disorder. Their role in psychosomatic illness consists of therapeutic and emergency services to suicidal patients as well as the prevention of symptoms for patients.10 A multidisciplinary approach with a variety of specialists is crucial in the diagnosis of psychosomatic disorder in women who have experienced trauma, violence, and abuse.3 Treatment According to a study, the most effective treatment for psychosomatic disorder is well-being therapy, which is a psychotherapeutic strategy that emphasizes self-observation. It helps patients to improve their interpersonal relationships and to be able to observe the symptoms they present in therapy.11 People suffering from psychosomatic disorder should be diagnosed by their primary care physician first, and then later referred to a psychiatrist for treatment. Age, competence, duration of the disorder, and the type of personality that the patient possesses must be taken into account when determining the treatment plan for the patient. The psychiatric treatments for a patient with psychosomatic illness may include 8 weeks of regular electroconvulsive therapy sessions, to help quickly reverse symptoms of the disorder.11 Some other psychiatric treatments include psychopharmacological treatments, such as antidepressants, which are most appropriate since they are the most common for this type of disorder.11 Treatment options can also include hypnosis to stimulate the subject to find her own subconscious healing resources. Furthermore, pharmacological abreaction, which involves interviewing individuals under the influence of a drug to elicit repressed emotions or traumatic experiences or to discover unconscious thoughts and feelings, can help a patient achieve emotional catharsis. Group therapy is also an option that helps the patients to learn, practice recovery strategies, and build interpersonal skills. Additionally, supportive psychotherapy administered by a psychiatrist helps to restore a person's relationship to social norms and regulations, while psychoanalysis works to strengthen the patient's relationship to their own subconscious mind.12 Each of these are available treatments that can assist women in achieving relief from psychosomatic disorder. Conclusion Psychosomatic disorder is harmful to a women's mental and physical health. Women who have experienced trauma and violence are more prone to suffer from this disorder. Patients can be left frustrated, with an unanswered question, as to why they are experiencing physical symptoms, while medical providers have difficulty identifying a medical explanation or diagnosis for their symptoms. Through physical afflictions varying from fatigue or infections to bruises and deleterious mental issues such as anxiety or depression, psychosomatic disorder is an illness that sends individuals downwards in a continuous cycle that they cannot comprehend. It is imperative to understand the spectrum of symptoms that can be associated with psychosomatic disorder as well as the reasons behind its development, including abuse and violence. Ultimately, what is a life-altering disorder that commonly appears self-inflicted, in reality, encompasses detrimental psychological obstacles that must be overcome to in order to bring resolution to the somatic ailments. Special Edition: Junior Clinical Research (2023), Vol. 3 No. S2 https://doi.org/10.47488/dhrp.v3iS2.85 DHR Proceedings ǀ http://dhrproceedings.org 27 2023, Vol. 2 No. S2 24-27 Acknowledgements Monica Betancourt-Garcia, MD, Program Director; Melissa Eddy, MS, Program Manager Funding Funded by DHR Health Institute for Research & Development; DHR Health; Region One ESC GEARUP College Ready, Career Set!; Region One ESC GEARUP College Now, Career Connected; Region One ESC PATHS; Region One ESC Upward Bound Math & Science; Benavides ISD; and Jubilee Academy-Brownsville References 1. Sweeting HN, West PB, Der GJ. Explanations for Female Excess Psychosomatic Symptoms in Adolescence: Evidence from a School-based Cohort in the West of Scotland. BMC Public Health. 2007 Oct 22;7:298. doi: 10.1186/1471-2458-7- 298. PMID: 17953744; PMCID: PMC2233615. 2. 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