Anxiety and Psychosomatic Illness

  • Chase Patterson Kimball


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.


Ulcerative Colitis Anxiety Disorder Personality Disorder Panic Disorder Psychosomatic Medicine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Diagnostic and Statistical Manual of Mental Disorders (Third Edition), American Psychiatric Association, Washington, D.C. 1980.Google Scholar
  2. 2).
    Kimball, C.P.: 1970. Conceptual Developments in Psychosomatic Medicine: 1939–1969 Ann. Int. Med. 73: 307–316.Google Scholar
  3. 3).
    Weed, L.L.: 1971. Medical Records, Medical Education and Patient Care, Cleveland, Case Western Reserve University Press.Google Scholar
  4. 4).
    Engel, G.L.: 1962. Psychological Development in Health and Disease. W. B. Saunders Co., Philadelphia.Google Scholar
  5. 5).
    Kimball, C.P.: 1981. The Biopsychosocial Approach to the Patient. Williams and Wilkins, Baltimore.Google Scholar
  6. 6).
    Engel, G.L.: 1961. Is Grief a Disease? a Challenge for Medical Research Psychosom. Med. XXIII: 18–22.Google Scholar
  7. 7).
    Beck, A.T.: 1973. The Diagnosis and Management of Depression Univ. of Penn., Philadelphia.Google Scholar
  8. 8).
    Seligman, M.E.P.: 1975. Helplessness: On Depression and Death. Freeman, San Francisco.Google Scholar
  9. 9).
    Bridger, W. H., Reiser, M.F.: 1959. Psychophysiologic Studies of the Neonate: an Approach Toward the Methodological and Theoretical Problems Involved. Psychosom. Med. 21: 265–276.Google Scholar
  10. 10).
    Sontag, L. W., Wallace, R.F.: 1934. Preliminary Report of the Fels Fund Study of Fetal Activity. Amer. J. Dis. Child. 48: 1050–1057.Google Scholar
  11. 11).
    Pavlov, I.P.: 1927. Conditioned Reflex. Oxford Univ., London.Google Scholar
  12. 12).
    Skinner, B.F.: 1963. Operant Behavior. Amer. Psychol. 18: 503–515.Google Scholar
  13. 13).
    Holmes, T.H., Rahe, R.H.: 1967. The Social Readjustment Rating Scale. J. Psychosom. Res. 11: 213–218.Google Scholar
  14. 14).
    Olin, H.S., Hackett, T.P.: 1964. The Denial of Chest Pain in 32 Patients with Acute Myocardial Infarction. J.A.M. 190: 977–981.CrossRefGoogle Scholar
  15. 15).
    Kornfeld, D.S., Zimberg, S., Malm, J.R.: 1969. Psychiatric Complications of Open Heart Surgery. Amer. Journ. of Psychiat. 126: 348–359.Google Scholar
  16. 16).
    Cassem, N.H., Hackett, T.P.: 1971. Psychiatric Consultation in a Coronary Care Unit. Ann. Int. Med. 75: 9–14.Google Scholar
  17. 17).
    Kimball, C.P.: 1969. Psychological Response to the Experience of Open Heart Surgery. Amer. Journ. of Psychiat. 126: 348–359.Google Scholar
  18. 18).
    Klein, R.F., Kliner, V.A., Zipes, D.P., Troyer, W.G., Jr., Wallace, A.G.: 1968. Transfer from a Coronary Care Unit. Arch. Int. Med. 122: 104–108.Google Scholar
  19. 19).
    Bilodeau, C.B., Hackett, T.P., 1971. Issues Raised in a Group Setting by Patients Recovering from Myocardial Infarction. Amer. J. Psychiat. 128: 105–110.Google Scholar

Copyright information

© Plenum Press, New York 1983

Authors and Affiliations

  • Chase Patterson Kimball
    • 1
  1. 1.Department of Psychiatry Pritzker School of MedicineThe University of ChicagoChicagoUSA

Personalised recommendations