ORGAN RESPONSES TO DISTURBING EMOTIONS

Cardio responsevascular

During a tantrum, blood clotting time is greatly decreased. In case of resentment, regret or anger, pulse, blood pressure and cardiac output are increased.

Anxiety increases heart rate, oxygen consumption and cardiac output, but decreases peripheral resistance. In heart patients, anxiety and resentment cause electrocardiogram changes.

Emotional effects on bodily functions are not just human. Myocardial infarction occurs in Kenyan baboons under emotional stress when they are trapped in the absence of cardiovascular disease. In this situation myocardial infarction occurs on a functional basis, probably caused by spasm of the coronary artery caused by anger.

Psychogenic fainting initiated by emotional factors such as fear is associated with an over-parasympathetic activation, leading to vasodilation in the splachial region and a decrease in circulating blood volume and loss of consciousness.

Gastro- responseintestinal

In patients presenting with gastro-bowel problems, they are caused more by a dysfunction than an organic disease. Gastric secretion is influenced by anger, joy and anxiety. Secretion of saliva, intestinal juices and bile are also affected.

Direct observation of the human colon by fistula and colostomy and of the gastric mucosa by gastrotomy have shown that fear, anxiety and pain lead to increased peristalsis, redness and swelling of the mucous membrane, while depression causes decreased motility and pallor of the mucous membrane.

Psycho symptomsSomatic may result from disorders of secretory function such as salivation, dry mouth, hyperchlorhydria, functional hyperinsulinism and mucous colitis or, alternatively, may be caused by disorders of motor function such as oesophageal spasm, gastric hypermotility, spastic colon, biliary dyskinesia, constipation and diarrhoea.

It is not certain whether a functional disturbance such as hyperchlorhydria resulting from psychosomatic disorders can cause peptic ulcer. Peptic ulcer can also occur after vagus and splachial nerve transection so it is more likely that emotional stimuli are only predisposing factors and not the underlying cause.

Skin response

The skin plays an important role in regulating body temperature through sweating and its functions are controlled by the autonomic nervous system. Vasoconstriction, vasodilation, pilomotor activity and sweating are four common physiological processes of the skin and they are largely controlled by the autonomic nervous system.

Thermal sweating differs from emotional sweating. Thermal sweating is more evident on the forehead, neck and the front and back of the torso and is controlled by the temperature centre in the hypothalamus.

Emotional sweating is more evident on the palms and soles and underarms. Patients with cold emotional sweating do not also have palmar sweating when exposed to heat, although other body surfaces respond to heat by sweating.

Itching can be purely psychogenic, independent of a specific arousal. Pruritus may be triggered by an emotional experience and this can be demonstrated by measuring intradermal histamine levels before and after emotional stress.

An increased tone of the sympathetic nervous system in tense patients is reflected by vasoconstriction of blood vessels in the skin. Sedation of anxious patients produces a decrease in excessive sympathetic nerve activity and restores normal dermal circulation.

Respiratory responses

The influence of emotions on respiratory function is expressed by expressions such as "mi s-took your breath away". The efferent innervation of the respiratory tract, which includes the nasal mucosa, consists of sympathetic and parasympathetic nerves.

The parasympathetic nerves have a constricting effect on the smooth muscles of the respiratory tract, while the sympathetic nerves have a relaxing effect. If parasympathetic stimulation of the lungs is excessive, over-stimulation occurs.secretion of mucous cells and an over-dilation of blood vessels. This causes swelling of the bronchial mucosa and congestion of the airways. In addition, the smooth muscles of the bronchial walls contract.

The effects of emotional factors are mediated by the parasympathetic nervous system, and acetylcholine, like histamine, can produce all the symptoms and tissue changes as in asthma. It can also affect the nasal mucosa. Thus, over-parasympathetic activation of the nose leads to thickening of the mucous membrane and a watery secretion typical of vasomotor rhinitis.

The emotional factors most likely to produce these parasympathetic effects are feelings of humiliation and resentment. Factors that lead to increased parasympathetic activity will stimulate vasomotor rhinitis or bronchial asthma.

Although hay fever is considered a prototype of allergic disorders, emotional factors play a stimulatory role in many cases, and in most patients with perennial rhinitis emotional factors play an important role. S-has shown experimentally that when the nasal mucosa is congested as a result of emotional stress, exposure to pollen, which does not normally produce symptoms, will cause hay fever.

Thus allergic responses are potentiated by emotional stresses both clinically and experimentally. Respiratory infections can cause mucosal cells to over-secretions, and the blood vessels dilate and this will prolong or intensify allergic asthmatic attacks.

Asthma is typically a disorder with multiple causation in which infection, allergy and emotional factors play an important role. Infection is the most important causative factor of a disease and is responsible for more than 50% of illnesses.

Allergies are responsible for 25% of illnesses and emotional factors for the other 25%.

It is important to realise that the main trigger of asthma is not the dominant aetiological factor in the course of the disease. Thus a child who develops asthma as a result of an infection may later have asthmatic attacks as a result of emotional stress.

Conclusion

It is important to emphasise once again that in most psychosomatic disorders there are few aetiological factors and the contribution of the emotional component is of considerable relevance.