The genesis of the behaviour mechanisms of the hypochondrical personality's disordersand their principles of psychodiagnostic research

Key words: psychodiagnostics, hypochondrical disorders, psychosomatic disorders, psychodiagnostic principles, hypochondriacal maladies, psychosomatics, psychodiagnostics.

Анотація

У статті зосереджено увагу на поведінкових механізмах іпохондричних розладів особистості та основних принципах їх психодіагностики. Вказано перелік симптоматичних особливостей розладу в умовах диференційних схожостей і відмінностей індивідуальних і загальних показників психодіагностичних принципів. Використанно загальнонаукові методи у вивченні різнопланових джерел і літератури, у результаті чого вдалося відтворити реальні факти досліджуваної проблеми з урахуванням наукового доробку вітчизняних науковців.

Ключові слова: психодіагностика, іпохондричні розлади, психосоматичні порушення, психодіагностичні принципи, іпохондричні розлади, психосоматика, психодіагностика.

hypochondriacal malady destructive psychosomatic

Stating the problem and its topicality. Ukraine's aspiration for integration to the European educational space realization is possible on the principles of conceptual re-thinking and the system of future specialists' professional training reform. Instability of economic, political and social conditions is accompanied by a disfunction of mental formations and disorders of the person's mentality. Nowadays the negative dynamics of somatic illnesses is being observed, in the origin of which a considerable etiopathogenetic role is played by the psychogenetic mechanism in the form of hypochondria display.

Aim. In the article we try to highlight the importance of psychosomatic health in the aspect of hypochondric disorders' genesis in illuminating the mechanisms of their development and the basic psychodiagnostic principles of the research.

Exposition of the main material. In the opinion of a number of scientists, the reason for the appearance of dreaming with hypochondric display is a result of the vegetative nervous system and the organs of the endocrine secretion [1 - 4].

S.A. Sukhanov in the book «Mental illnesses» describes hypochondric disorders in the chapter dedicated to involutional mental illnesses and has singled out their hypochondric form. He connects the appearance of fixed ideas with the insufficient function of the organs of the endocrine secretion [1, 2].

According to V.M. Bekhterev, the disorder of the vegetative nervous system and the organs of the endocrine secretion, adrenals in particular, is the basis for the hypochondric state [2, 3].

S.I. Kharchenko underlines, that hypochondric disorders are typical for mental disorders when illnesses of the endocrine system occur. Z.I. Izrailovich states, that hypochondric syndrom is typical for the climacteric disorders [1, 4].

It's impossible to disagree with the opinion of the authors, who think, that the appearance of hypochondric ideas is connected mainly with the disorders of the vegetative nervous system and the endocrine disorders. They don't pay any attention to functional disorders of the cerebral cortex and pathologic introceptive impulses, but meanwhile these disorders are the initial ones in the hypochondric state pathogenesis.

Later on in order to explain the aetiology of the psychologic states some research about the constitutional heredity has been used. Hypochondria according to the theory of degeneration appears as a secondary factor in the formation of psychosomatic disorders. All this is represented in the metaphysical study about degeneration and hereditary provision and has been widely spread among the psychiatrists, especially in the West European countries.

In 1857 Morel published his research about degeneration. He defined degeneration as «painful deviation from the primary type, it has an aptitude for delivering heredity». Schule pointed out, that hypochondria appears as a result of the constitutional degeneration and deep touchable sufferings of the brain, that change into the age atrophy [1, 3].

One more German psychiatrist Grizinger insisted on the same positions. He considered the problem of interconnection between the mentality and the brain to be unsolved. He stated, that the explanation of all happening in the soul cannot be solved neither by materialism, that emphasizes physical conceptions about mental illnesses, nor by spiritualism, that is explaining physical by the soul. Grizinger considered hypochondria to be a form of melancholy, in the origin of which the peculiarities of the sick person have the primary meaning.

Kraft-Ebing in his classification of psychosis referred hypochondric status to the constitutional illnesses. He connected hypochondria to the neurosis of the sensitive sphere «neurosis of the general feelings» and considered hypochondric dreaming to be the initial madness - paranoia hipochondrica. In his opinion this madness can be developed by the genetic disposed people [1, 2].

The famous German psychiater Weber takes even more open positions concerning hereditary predestination of the psychic illnesses. He stated that all somatic illnesses depend on the condition of the nervous system. Hypochondric illness, in the origin of which an important role is played by heredity, is delivered by means of homogeneous genetic inclination or a person is the only bearer of the affected nervous system [1, 4].

In the end of the nineteenth and in the beginning of the twentieth century the study about «fatal» heredity and degeneration was so widely spread, that the majority of the psychiatrists considered the etiology of the hypochondriacal disorders as the initial one in the origin of the whole somatics. In the American issues the reactionary study about degeneration and the constitutional disposition to illnesses is actual even nowadays. American psychiatrists construct a theory concerning dreamings from the point of view of the Freud's model of pansexuality. Masserman agrees with Freud's psychoanalytic conception and consideres it to be relatively simple, logic and successive. The successiveness of the conception is seen from the following evidences of the American doctor Sterling, who described the ulcerous colitis: «In all the cases, - comments the doctor, - one can find the amount of blood in the secretion within the given time proportional to the intensiveness of the manifestation of oral or anal sadism» [1 - 4 ].

It is important to mention, that the newest for that time tendencies about constitutional studies, degeneration and heredity have found their reflection in the studies of some Soviet psychiatrists. A.M. Evlakhov in his article about patoplastic elements of dreamings appearing stated, that the person's constitution plays the most important role. He supported Krechmer's point of view and often cited it in his works [1, 2].

The ideas of I.P. Pavlov about the development of mental illnesses and neurosis are actual now concerning the explanation of hypochondric illnesses development mechanism. A number of researches prove the pathogenetic mechanisms of these illnesses from the positions of nervism. It is important to underline the works by A.G. Ivanov-Smolenskyi, V.P. Protopov, V.A. Hiliarovskyi, N.I. Bondarev, V.N. Miasischev, A. S. Chistovych, N.P. Titarenko, I. O. Narbutovych, E.A. Popov, A.V. Snezhnevskyi, O.V. Kebrikov, I.V. Sluchevskyi, N. A. Khromov and some others [1 - 7].

V. A. Hiliarovskyi described the so called cathestesic dreamings, in the genesis of which the unpleasant feelings in a person's organism appear within the main pathogenic process [1, 2].

E.E. Skanava connects the origin of the children's hypochondric disorders with the vegetative insufficiency of the organism, induced by the injury, infection and other similar pathogenic factors. The author doesn't exclude the possibility of personal characteristics influence on the development of the person [1, 3].

N.N. Zotina in the structure of the hypochondric syndrome accentuates the so called superficial pathological introceptive feelings and affective emotional experiences (the fear of death) [1, 4].

Е.М. Kholodkovska considers the neurosomatical disfunctions, caused either by the inborn or acquired weakness of the separate systems or organs, that cause physical feelings and lead to the development of the fixed ideas, to be the genesis of the hypochondric state.

V.E. Halenko underlines the importance of the hypochondriac syndrome exhaustion of the nervous system. Y. E. Sehal, studying the hypochondriac conditions by the wounded, made a conclusion, that pathologic introspective feelings and psychic effects play an important role in the structure of the wounded hypochondriac syndrome [1, 2].

Nowadays we accentuate the studying of the pathophysiological mechanisms with the usage of various psychodiagnostic methodologies. For example, V.S. Kulikov, A.T. Pshonyk, Y.E. Sehal and S.I. Kohan with the help of plethysmography have studied the unconditional vascular reaction of sick people with hypochondriac syndrome. The studies showed that vascular reactions are among these sick people are changed: they are either paradoxical or unclear, or they may be event absent. Y.H. Kozlov marked the changes of the functional conditon of the cerebral cortex of cats and dogs in cases of interoceptive sensors irritation by some pharmacological substances. A.S. Chystovych indicates that hypochondriac syndrome appears as a result of interoreception's changes, as a result of reasons in mechanism changes, that have been studied by I.P. Pavlov for the physiological understanding of dreaming, - in pathological inactivity and ultraparadoxical phase [6, 7].

O.V. Kerbikov also thinks, that interoreception is an important aspect in cases of hypochondriac conditions appearance. In his opinion, the genesis is caused by the disturbance of the dynamics and the inner organs pathology (interoreception). The last one can have both conditioned and inconditioned (constitutional) character. Having interpreated the scientific heritage of I.P. Pavlov about high nervous activity we'll point out the possibility of creating conditioned reflexes by the irritation of the inner organs. The mechanism of creating these reflexes is the same as with conditioned exteroceptive reflexes. The differences can be observed only concerning the facts, that in some cases the interoceptive reflexes are formed as temporary formations and can be supressed quite quickly. This peculiarity has great importance in cases of hypochondriac positions [1 - 4].

Theoretical and methodological basis of the research is also based on the principles of scientific character, systematic and complex approaches.

The objectivity during the coverage of the topic was secured by the implementation of unbiased, nonconjunctive conclusions, taking into account the views of the previous researchers, and reliable, verified information from selected sources. At the same time, we did not escape critical judgments and evaluations for a realistic demonstration of a number of psychosomatic problems in the genesis of hypochondritic disorders.

Due to the usage of the comprehensive approach principle, we took into account the current trends in the development of prevention and health care, as well as a variety of factors that influenced the results, the nature and significance of changes in the treatment of hypochondriac disorders among humans. Among them: cultural introduction in the pedagogical process of the disciplines of vocational and preventive measures, sources of preservation of the state of optimal human functioning in cases of development of hypochondria, level and mechanisms of psychological protection, level and possibilities of means of resistance of the organism to hypochondriac stressors, psychosomatic correlates of psychological stability of the individual in a state hypochondriactic dependence.

The systematic principle allowed to reveal the integrity of the object of study, taking into account the influence of objective and subjective factors, in particular the internal picture of the disease, its features in sociometric measurements during the study period.

The complexity presupposed the coverage of the basic principles of diagnostics by the multimodality of methods for collecting information on the etiology of the disease. In its context, account is taken of the ability to integrate information obtained by different methods. In particular, emphasis is placed on the disclosure of the following structures:

- biological precondition includes biochemical, neurophysiological, psychophysiological spheres; in the foreground, somatic processes that can be fixed by physical or chemical means are taken into account;

- the psychological (psychological) premise is accentuated on the internal individual experience and behavior (including activity) of the individual;

- social premise produced by interpersonal relations in the society (social conditions, family situation);

- ecological premise: in this perspective, living conditions, material security, and quality of life are considered.

At this time there are many options for system analysis of problems. Let's dwell upon the most famous of them. For example, the multimodal Lazarus profile is a specifically organized seven-way system analysis, BASIC-ID (in the first English letters: behavior, impact, sensation, imangination, cognition, interpersonal relation, drugs - behavior, affect, sensation, presentation, cognition, interpersonal relationships, drugs and biological factors). The use of a multimedia profile allows you to better enter the patient's problem, it is coincident with the differential diagnosis of mental disorders and allows you to simultaneously choose options for psychotherapeutic care. In our case, we offer a multimedia profile of a patient with hypochondriaal disorders in the aspect of psychosomatic illness (sore duodenum) (table 1).

This approach is recommended in case of the first conversation with the patient during the collection of a detailed history of the disease. Another multimodal approach from Oudehoorn (1993) that can be used during the family psychotherapy. It is presented as a "six-layer pie" of six levels. Each level reflects the corresponding biopsychosocial theories, which serve to confirm the hypothesis and the choice of psychotherapeutic interventions. Oudehoorn's approach is multimodal, and when applied, psychoanalytic, behavioral, cognitive, communicative and systemic family theories are used that do not contradict each other.

Table 1

Multimedia profile of the sick person A. with hypochondriac disorders in the aspect of psychosomatic illness (sore duodenum)