Psychogenic rheumatism; the musculoskeletal expression of psychoneurosis.

For the development of a psychosomatic disorder there are three requisites: (1) a psychoneurotic predisposition; (2) an exciting emotional conflict, and (3) restriction of outward expression of the conflict. All individuals, whether normal or psychoneurotic, seek relief from the mental suffering occasioned by disturbing life problems. When emotional tension is expended by outward expression, muscular or verbal, all is well. By taking some form of action or doing something about it, the individual " gets it off his chest " and feels better. But if emotional dissipation is constantly restricted, the tension gradually mounts and, in a psychoneurotic type of individual especially, the development of somatic complaints may be the eventual outlet. With the emergence of bodily symptoms the psychoneurotic tends to focus his attention on them, and thereby is partially relieved from his inner mental tension. The psychophysiologic mechanism by which psychic disturbances are displaced into physical symptoms is not fully understood; undoubtedly it is complex. Recent studies suggest that emotions may affect the autonomic nervous system either directly or through the endocrine system, thereby producing increased muscle tension, vasospasm, or metabolic changes in various organs and structures. Physicians in general are familiar with those functional symptoms or symptom complexes which are expressed in various systems, exclusive of the musculoskeletal system. The idea that structural changes in certain organs may result from psychic disturbances is also being accepted. The following is a partial list of disorders now recognized as psychosomatic: gastrointestinal system-functional dyspepsia, anorexia nervosa, irritable colon, cardiospasm, pylorospasm, certain cases of peptic ulcer and of chronic ulcerative colitis; cardiovascular systemneurocirculatory asthenia, effort syndrome, functional arrhythmias, acrocyanosis, Raynaud's disease, and certain cases of hypertension; respiratory system-certain cases of asthma, allergic rhinitis, and chronic bronchitis; genito-urinary systemenuresis, vaginismus, certain cases of impotence, and dysmenorrhoea; nervous