Neurosis of the stomach and intestines, signs, symptoms

Having an obsessive idea about the constant need to find out the cause of complaints in the gastrointestinal tract, as a rule, such patients undergo repeated complex clinical and instrumental examinations using all possible options of modern medicine. As a result, it is often possible to detect certain minor changes in the form of superficial gastritis, impaired motility of the upper gastrointestinal tract, thickened gallbladder walls, irritable bowel, etc. At the same time, traditional therapy prescribed in such cases shows its ineffectiveness, examinations in laboratories and diagnostic rooms are repeated and complicated, and taking into account neurotic disorders and identifying them as the cause of malaise in the gastrointestinal tract is late.

As the experience of the Department of Neuroses and Psychotherapy of the Psychoneurological Institute named after V.M. Bekhterev, patients with neuroses with gastrointestinal dysfunction often undergo unsuccessful treatment by gastroenterologists for many years, undergoing repeated examinations. For example, 102 such patients underwent a total of 1,100 pre-soundings (gastric and duodenal), 820 fibrogastroduodenoscopy, 530 X-rays of the stomach and intestine, more than 180 irrigoscopies, 480 cholecystographies, 320 ultrasound diagnostics of the liver, bile ducts and pancreas. At the same time, 11 patients even underwent invasive examinations, such as aortography, and 6 patients - laparoscopy. All patients had a large pile of medical prescriptions and discharge summaries, gastritis or gastroduodenitis was present at some point in each patient, every second patient had chronic cholecystitis, and every fourth patient had chronic pancreatitis.

Some patients had previously undergone treatment not only in therapy but also in surgery. All surgical interventions were not only useless but also harmful, since they contributed to the deepening of depressive and hypochondriacal syndromes against the background of postoperative asthenia.

Among those who applied to the neurosis department, more than 60% were women. The average age of all patients was 36.5 years. During the examination of patients, an abundance and persistence of gastrointestinal dysfunctions were established, on the one hand, and on the other, signs of severe neurotic disorders were noted. This exactly corresponds to the known principles of positive and negative diagnostics of neuroses.

Among patients with psychosomatic disorders with a predominance of gastroenterological symptoms, it is customary to distinguish three groups of conditions:

• neurotic disorders of gastrointestinal functions;
• neurotic fixation of mild pathology of the digestive organs;
• neurosis-like disorders that complicate the course of chronic diseases in the field of gastroenterology.

Until now, clear mechanisms for the formation of systemic neuroses have not been found, on which organ or system the "choice " will fall, which ultimately leads to the determination of the specificity of the neurosis. The choice of a symptom or a complex of symptoms may depend on the unsatisfied need, unconscious conflict, motivational experiences, temperament, emotional experience options, basic protective functions, personal experience, lifestyle, type and strength of psychological trauma, etc. Vegetative disorders are certainly present in the development of visceral neurotic disorders. It is also necessary to take into account the hereditary and constitutional features of the state of life support systems. In this case, it is the mental factor that acts as a provoking moment. A certain significance can also be given to the acquired features of the system due to injuries, infections and intoxications suffered during life.

Some of the examined patients were found to have a hereditary burden of psychopathy (29.8%), alcoholism (22.2%), neuroses (18.5%). Also found were dissatisfaction in the sexual sphere (93%), defects in upbringing (85%), psychotraumatic reasons in one's own family (74%), unfavorable housing and living conditions (63%), conflicts at work (59%), and other significant changes in life (59%).

Clinical studies of patients using self-assessment questionnaires indicate that most of them are dissatisfied with themselves, dependent on others and susceptible to other people's influence, indecisive, conflict-prone, have aggressive emotions and reactions, and tend to react affectively to disappointments.

By type of neurosis, patients were divided as follows: hysterical neurosis - 70.4%, neurasthenia - 22.2%, obsessive-compulsive disorder - 7.4%. The most pronounced were the combined types of character accentuations, especially demonstrative with asthenoneurotic (33%) and sensitive (26%).

The symptoms of different forms of neurosis had specific gastroenterological inclusions. For patients diagnosed with "Hysterical neurosis", vivid descriptions and manifestations of deviations in the digestive area, an acute desire to "have a diagnosis", and to undergo surgical treatment are more typical. With neurasthenia, on the contrary, a desire to make sure that there are no serious diseases of the gastrointestinal tract is more often found, which entails numerous repeated hospitalizations and examinations. Physical processing of complaints about the stomach and intestines, an emphasis on dietary nutrition, persistent oppressive cancerophobia (fear of getting cancer) are typical of obsessive-compulsive neuroses.

Clinical types of gastrointestinal disorders are varied and numerous. Most often, the so-called gastric neuroses are observed, which have the following names: irritable stomach syndrome, pseudoulcer syndrome, non-ulcer dyspepsia, functional dyspepsia, neurogenic gastric dyspepsia, etc.

In gastroenterological practice, two types of neurotic vomiting are mainly distinguished: hysterical and habitual. If the first usually occurs in a stressful environment, along with certain emotions, and is characterized by a demonstrative shade, then the second appears in a calm environment, as an expression of suppressed emotions. Neurotic vomiting is also known, which occurs as a combination of induction and imitation, for example, due to prolonged contact with family members suffering from vomiting due to stomach cancer. Psychogenic vomiting usually occurs easily, without painful efforts and preceding nausea. The vegetative components of this type of vomiting, which include pale skin, sweating, etc., are usually weakly expressed or absent. Even if frequent neurotic vomiting is observed, severe exhaustion does not occur.

A common manifestation of neurotic stomach disorders is gastralgia. There is a close relationship between emotional stress and the occurrence of unpleasant symptoms in the stomach (heaviness and distension in the epigastric region, pain, burning), while complaints do not depend on the nature of nutrition.

Also, attention should be paid to rare minor monosymptomatic disorders that manifest themselves as unpleasant sensations in the upper gastrointestinal tract: psychogenic halitosis (an imaginary sensation of bad breath), dysgeusia (taste disorder with a sensation of bitterness in the mouth that has nothing to do with food), nausea (in combination with dry mouth or increased salivation), glossodynia (impaired sensitivity of the tongue with possible tingling or burning), a lump in the throat, etc.

If we consider psychogenic esophageal spasm, which manifests itself as persistent dysphagia, it can be noted that patients have difficulty swallowing at any section of the esophagus, while liquid passes more difficultly than solid food. Sometimes a spasm occurs during a meal after severe mental stress, after which it is repeated almost at every meal. The sensation of esophageal spasm may also be present outside of food intake, expressed in pain or a feeling of compression behind the breastbone, which is often mistaken for angina. Against the background of esophageal spasm, severe anxiety and fear of eating appear. Some patients develop cancerophobia and severe asthenohypochondriacal syndrome. The classic neurotic syndrome is globus hystericus, which is mainly inherent in young women. In this case, there is a feeling of a foreign body (lump) in the throat, squeezing or a burning sensation in the neck, which usually subsides during food intake.

No less frequent and diverse are clinical neurotic disorders of the intestine, called irritable bowel syndrome, mucous colic, intestinal dyskinesia, etc. In addition to the primary, neurogenic variants of this syndrome, secondary dyskinesias are often noted, the cause of which are other diseases, and there are also mixed variants of pathology. Neurogenic pain in the intestines (cramping, dull, distending, burning, etc.) usually becomes stronger during periods of emotional tension and stress. There are problems with the functioning of the intestines in the form of acute pain, flatulence, loud rumbling, increased gas formation and frequent urge to defecate. Against this background, the patient may develop a state of anxious expectation of a recurrence of unpleasant phenomena, which makes it difficult to visit public places, meet people and can become a reason for severe experiences.

Nervous prerequisites play a special role in the development of chronic constipation. People with neuroses often show increased attention to the act of defecation, focus on the frequency, quality and quantity of their bowel movements, which forms a severe hypochondriacal syndrome and further aggravates constipation. No less than that, psychogenic loosening of the stool ("bear disease") is also noted. In patients with diarrhea, the urge to defecate often occurs in the most inappropriate place, which negatively affects the psychological state. Often, intestinal upset occurs at night or in the morning, waking the patient, which results in insomnia and increases asthenia.

The neurotic moment is also observed in the pathogenesis of some types of rectal neuralgia, as well as continuous anal itching.

Functional neurotic disorders of the gastrointestinal tract also include aerophagia, which often occurs with hysterical neurosis. Increasing and persistent attacks of flatulence in this case sometimes imitate pregnancy or manifest themselves in the form of loud belching. In this case, pain in the left half of the chest, reflex tachycardia are also possible.

A number of the described gastrointestinal disorders against the background of neuroses also complement moments of pathology of proper food intake. Overeating or unbalanced nutrition, as a type of compensation for the lack of positive emotions, are the basis of many cases of obesity and, conversely, severe weight loss, called anorexia.

Treatment of gastrointestinal dysfunction against the background of neuroses

Treatment of patients with gastrointestinal dysfunction on a nervous basis is provided to them according to the general rules of therapy for neuroses, while psychotherapy is usually the primary principle of eliminating pathologies. Person-oriented psychotherapy is used both in group and individual forms. Its goal is to achieve the patient's understanding of the connection between gastrointestinal dysfunction and neurological disorder and, if possible, to change the disorders that caused the neurosis. The task of the psychotherapist is to expand the range of emotional reactions of patients with a gradual transformation of the value system and switching their attention to resolving psychological problems.

A gradual transfer of patients from gentle diets to physiological nutrition with a sufficient amount of protein and vitamins is almost always appropriate. In advanced cases of severe dystrophy against the background of nervous anorexia, as part of intensive therapy, the patient is temporarily given food through a tube.

Gastroprotectors, enzyme preparations, antacids, antispasmodics and other drugs have both a direct and indirect effect in the treatment of gastrointestinal disorders against the background of neuroses. Homeopathic preparations are no less useful due to their gradual, gentle effect.

Tranquilizers and antidepressants also have a positive effect in the treatment of neurotic disorders of the digestive organs.