Ogorenko V. V., Shornikov A. V.


About the author:

Ogorenko V. V., Shornikov A. V.



Type of article:

Scentific article


Chronic stress, including those caused by the presence of chronic pathology, has a significant effect on the course of the disease: feelings of social isolation and its connection to the inflammatory response are common to both depression and many somatic conditions. About 30% of patients have clinically significant levels of distress or ineffectively cope with stress, which leads to problems of adaptation, depressive states, problems of overcoming pain, fatigue. In the absence of some specialists in psychosomatic medicine help these patients provide various specialists. If the treatment of patients with conversion and dissociative disorders in psychiatrists does not raise objections in either doctors or patients, then functional psychosomatic disorders are usually treated by doctors of therapeutic profile. In the article is proposed a unified approach for understanding psychogenic, in particular psychosomatic disorders. In developing a look at the pathogenesis of neurotic disorders as a result of an immature defense mechanism, the primary purpose of which is to protect against the mismatch between “want and can”, which generates a stress (adaptation) response, we propose a scheme for the development of psychosomatic disorders. The proposed model is based on the psychodynamic the Freudian theory of personality and the mechanisms of psychological defense by A. Freud, and is integrated K. Rogers “self-concept theory”, H. Selye’s stress theory, and coping strategies by R. Lazarus. Based on the discussed model of the psychogenic disorders` development, a key role is given to anxiety, which appears as a discrepancy between “I-ideal” and “I-real”. Further, this anxiety can be affected by both coping strategies and the mechanisms of psychological defense, which can eventually lead to the development of psychosomatic disorders. If the anxiety is fully understanding, it is possible to use some coping strategies, such as problem solving, seeking social support, avoiding it. Another option is to take action if the person does not knowingly do something to overcome the anxiety that has arisen. It includes mechanisms for psychological protection from anxiety. Thanks to the mechanism of displacement, anxiety is displaced from the conscious (“Ego”) into the unconscious (“It”). Its consequences are to keep anxiety in the personality, but without its awareness, that is, all physiological changes persist, but the person is no longer aware of anxiety. Later on concerns continue to apply other defense mechanisms. When beginning to affect mechanisms such as conversion and dissociation, it leads to conversion and dissociative disorders. If a mechanism such as somatization takes effect in the “It” anxiety, it leads to functional psychosomatic disorders, which, according to ICD-10, are somatoform disorders (F45). The proposed model of the psychosomatic disorders` development may also explain the occurrence of generalized anxiety disorder, panic attacks, post-traumatic stress disorder, and chemical addictions, and may be useful in studying the etiology and pathogenesis of psychogenic and psychosomatic disorders at both undergraduate and postgraduate levels of education. For example, post-traumatic stress is explained by the impact of non-adaptive coping strategies with the anxiety background of that “feeds in” from intrapersonal conflict with the addition of periodic anxiety due to the inferiority of the displacement mechanism.


neurotic, stress-related, somatoform disorders, depression, psychotrauma, defense mechanisms.


  1. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016 Feb;3(2):171-8.
  2. Vigo D, Jones L, Thornicroft G, Atun R. Burden of Mental, Neurological, Substance Use Disorders and Self-Harm in North America: A Comparative Epidemiology of Canada, Mexico, and the United States. Can J Psychiatry. 2019 Nov 20;070674371989016.
  3. Consoli SM. La recherche psychosomatique en 2018: illusions perdues, espoirs renouvelés. Rev Médecine Interne. 2018 Dec;39(12):955-62.
  4. Evers AWM, Gieler U, Hasenbring MI, van Middendorp H. Incorporating Biopsychosocial Characteristics into Personalized Healthcare: A Clinical Approach. Psychother Psychosom. 2014;83(3):148-57.
  5. Bellomo A, Altamura M, Ventriglio A, Rella A, Quartesan R, Elisei S. Psychological Factors Affecting Medical Conditions in Consultation-Liaison Psychiatry. In: Porcelli P, Sonino N, editors. Advances in Psychosomatic Medicine [Internet]. Basel: KARGER; 2007 [cited 2019 Nov 25]. p. 127- 40. Available from: https://www.karger.com/Article/FullText/106801
  6. Karavaeva TA, Kocjubinskij AP. Holisticheskaja diagnostika pogranichnyh psihicheskih rasstrojstv. SPb.: SpecLit; 2018. 286 s. [in Russian].
  7. Fava GA, Sonino N, Wise TN. Principles of Psychosomatic Assessment. In: Fava GA, Sonino N, Wise TN, editors. Advances in Psychosomatic Medicine [Internet]. Basel: KARGER; 2011 [cited 2019 Nov 25]. p. 1-18. Available from: https://www.karger.com/Article/FullText/329997
  8. Voloshyn PV, Maruta NO. Osnovni napriamky naukovykh rozrobok v nevrolohii, psykhiatrii ta narkolohii v Ukraini. Ukrainskyi Visnyk Psykhonevrolohii. 2017;25(1):10-8. [in Ukrainian].
  9. Porcelli P, Todarello O. Psychological Factors in Medical Disorders Assessed with the Diagnostic Criteria for Psychosomatic Research. In: Fava GA, Sonino N, Wise TN, editors. Advances in Psychosomatic Medicine [Internet]. Basel: KARGER; 2011 [cited 2019 Nov 25]. p. 108-17. Available from: https://www.karger.com/Article/FullText/330009
  10. Sidorov PI, Parnjakov AV. Vvedenie v klinicheskuju psihologiju: uchebnik dlja studentov medicinskih vuzov. Vol. 2. Moskva: Akademicheskij Proekt, Ekaterenburg: Delovaja kniga; 2000. [in Russian].
  11. Nakaz vid 05.02.2007 № 59 Pro zatverdzhennia klinichnykh protokoliv nadannia medychnoi dopomohy za spetsialnistiu „Psykhiatriia» [Internet]. MOZ Ukrainy; 2007. Dostupno: http://www.moz.gov.ua/ua/portal/dn_20070205_59.html [in Ukrainian].
  12. Kostyuk GP, Masyakin AV, Starinskaya MA. Organizacija psihiatricheskoj pomoshhi v ambulatornopoliklinicheskih uslovijah pri rasstrojstvah trevozhnogo i depressivnogo spektra. Psihiatrija. 2017;76:5-11. [in Russian].
  13. Spirina ID, Tymofeyev RM, Shornikov AV. Rol stresovoi reaktsii i ‘nezrilykh psykhichnykh zakhysnykh mekhanizmiv u formuvanni nevrotychnykh, poviazanykh zi stresom i somatoformnykh rozladiv. Ukrainskyi Visnyk Psykhonevrolohii. 2018;26(1):92-4. [in Ukrainian].
  14. Freud S. Neuro-Psychoses of Defence [Internet]. Read Books Ltd.; 2014 [cited 2017 Nov 2]. Available from: http://www.myilibrary. com?id=852502
  15. Rogers CR, Dymond RF. Psychotherapy and personality change: co-ordinated research studies in the client-centered approach. Chicago: University of Chicago Press; 1978.
  16. Sel’e G. Stress bez distressa. M.: Progress; 1979. 109 s. [in Russian].
  17. Cerkovskij AL. Sovremennye vzgljady na koping-problemu. Vestnik Vitebskogo Gosudarstvennogo Medicinskogo Universiteta. 2006;5(3):1-15. [in Russian].
  18. Freud A. Das Ich und die Abwehrmechanismen. Ungekürzte Ausg., 22. Aufl. Frankfurt am Main: Fischer-Taschenbuch-Verl; 2012. 175 p. (Fischer-Taschenbücher Geist und Psyche).
  19. Nuller JuL, Cirkin SJu, redactory. Mezhdunarodnaja klassifikacija boleznej (10-j peresmotr). Klassifikacija psihicheskih i povedencheskih rasstrojstv. Klinicheskie opisanija i ukazanija po diagnostike. SPb.: Adis; 1994. 304 s. [in Russian].

Publication of the article:

«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 14-17 pages, index UDK 616.89-008:616.891