Psychosomatic factors in duodenal ulcer disease

Psychological factors may play an important role in peptic ulcer disease, but this has not yet been proven. The psychosomatic theory suggests than an unconscious conflict, by some yet unknown route, results in an increase in acid-pepsin secretion or a decrease in resistance of the duodenal mucosa, thereby upsetting the normal balance between injurious and defensive factors. At least some ulcer patients have a conflict over an exaggerated need for dependency and a desire to be a self-sufficient adult. In a prospective study [13] aimed at predicting individuals predisposed to ulcer disease, the presence of this dependent-independent conflict was confirmed. Since this personality profile was found to be associated with hyperpepsinogenemia which has since been shown to be genetically determined, the intriguing possibility exists that the psychological traits are also genetically determined. This personality profile may be associated with a predisposition to ulcer disease, but so far there is no clearcut evidence showing that the psychological factor actually influences the gastrointestinal disorder. Clinical experience suggests that "stress" is frequently a contributory factor to exacerbations of the ulcer disease. We are coming to recognize that a number of different pathophysiological mechanisms may lead to a duodenal ulcer. It seems that psychological factors may be found to be important in some forms of the disease and not in others. Consideration of psychiatric treatment should be based on the individual's psychological characteristics and not solely on the presence of ulcer disease.