Psychogenic Explanations of Physical Illness: Time to Examine the Evidence

Perspect Psychol Sci. 2016 Sep;11(5):606-631. doi: 10.1177/1745691616645540.

Abstract

In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable "organic" diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable "organic" illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.

Keywords: functional neurological disorder; psychogenic; psychogenic movement disorders; psychogenic nonepileptic seizures; somatic; somatoform.

Publication types

  • Review

MeSH terms

  • Humans
  • Psychophysiologic Disorders / diagnosis
  • Psychophysiologic Disorders / etiology
  • Psychophysiologic Disorders / physiopathology*
  • Psychophysiologic Disorders / therapy*
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / etiology
  • Somatoform Disorders / physiopathology*
  • Somatoform Disorders / therapy*