1. The fallacy of separating somatic and
psychological symptoms.
September 30 , 2013
St. Maarten
Erik Hoencamp

2. Two realities
• Split in classification and treatment of somatic or
psychological symptoms.
• Leading to split between professionals, research, training
curricula and financing of care.
• While
• They co-occur in many clinical situations.
• With regard to genetic vulnerability , environmental risk
and protective factors they have the same etiological
underpinning.

3. Conceptual background
• Gene * environment Interaction.
• Examples of disease/phenotype
Depression<> Cardiovascular Disorders
Bipolar Disorder, Schizophrenia<> metabolic syndrome.
• Childhood Adversity as an environmental
factor

4. Current paradigm,
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics

5. Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics
Childhood adversity
Depression
Cardiovacular disorder.
Metabolic Syndrome
Psychosis

7. Depression & Cardiovascular disease
• Share genetic vulnerability and
environmental component.
• In clinical practice co-occur often , proper
treatment of depression enhances life
expectancy. (psychotherapy ,
antidepressants, treatment CVA)
• NB depends on definition Major
Depressive Disorder.

8. Schizophrenia
Bipolar disorder
Depression ??
Anxiety disorders ??
Diabetes
Hypertension
Cardiovascular
Etc.
Metabolic
syndrome both
cause and
consequence of
the disorder?
Life style
Medication

10. Environment
social
Migration,dicrimi
nation,etc
family
psychological
physical
economic
Childhood Adversity

11. Depression
Anxiety
Etc.
Cardiovascular
disease
Inflammatory
disease
etc
Affective
Physical
Sexual
Which has highest impact ???

12. Example how ACE
effects health
In this case
cardiovascular
disorders

13. So, related are
• Depression <>Cardiovascular Disorder.
(Genetic component)
• Schizophrenia /Bipolar Disorder<>
Metabolic syndrome. (Genetic component)
• Childhood Adversity (environmental
component)<> Depression
&Cardiovascular Disorder

14. Is there a common denominator
in the pathogenesis ?
• Epigenetic changes in gene expression
• Stress regulation functioning HPA-axis
• Aberrant Inflammatory processes
• Disruptive Bio-rhythms
• Microbiome ?
• Socio-economic risk and protective
factors.

15. Domains or levels of expression of pathology
Social , economic, political situation.
Life events risk and protective factors
Behaviour
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context.

16. Pathology “ X “ and attributed causality.
Social , economic, political situation, Life events risk and protective factors
Behavior
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context
Pathology X
Somatic Psychological

17. Pitfalls separating psychopathology and somatic
pathology
• Psychopathology implies that the
phenotype/disease is caused by
“psychological” factors.
• Somatic pathology implies that it is caused
by an underlying disease.
• Neither is true and leads to strange
situations what is a “ real “ disease
example whiplash , CFD, ..

18. What are practical the consequences
• Image : psychopathology, remains having a negative
odium and easily leads to stigmatization and rejection.
Religious, ideological and political factors play a role in
these processes.
• Research and treatment: A fundamental change is
needed and slowly in progress where somatic and
psychological symptomatology and their relation are
taken into account with regard to etiology and treatment.
• Training curricula should be adapted and give more
background about both psychological and biological
aspects of disease.
• Our own attitude : well intended we may contribute to
stigmatization, by treating patients different with
psychopathology leading to dependency and lack of self
fulfillment and empowerment.
• Organization of health care services , Challenge to
increase cost effectiveness of health care .

19. Thanks any questions ?