Psychogenic explanations of physical illness: Time to examine the evidence, 2015, Wilshire & Ward

Wilshire, Carolyn & Ward, Tony. (2015). Psychogenic explanations of physical illness: Time to examine the evidence. Perspectives on Psychological Science 2016, Vol. 11(5) 606–631.
https://pubmed.ncbi.nlm.nih.gov/27694458/
(paywalled)

Abstract

In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause.

In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions.

First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable "organic" diagnosis, so a causal role cannot be inferred.

Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience.

Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable "organic" illnesses, there is currently no evidence to support this claim.

Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed.

We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.


Full text at research gate: https://www.researchgate.net/public...physical_illness_Time_to_examine_the_evidence

Spoiler: Paper on Sci-hub

https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/27694458

 

Thank you for posting!

The observation that this was published from the department furthest from Oxford, Kings etc psychology depts makes me wonder whether there's an inverse-square law at play.

 

They are also doing better work than some at the Health Psychology Dept at the Uni of Auckland eg. Prof Petrie. Carolyn Wilshire also did a paper on PACE which helped inform psychology and psychiatry professionals in NZ. https://www.researchgate.net/profil...-the-PACE-trial.pdf?origin=publication_detail

Very good paper. She does argue not to use the word Psychogenic which I heard being kicked around frequently by physicians, surgeons and nursing staff. But it was not part of my vocabulary in psych and these terms were frowned upon as being wrong and stigmatising. I saw several cases of adolescents with epileptic fits without EEG changes while training and were taught they were due to brain dysfunction due to epilepsy rather than secondary gain and often they disappeared without intervention and better for them not to be living on a neurology ward getting continuous EEG to prove they were “faking” it by physicians….and for them and their family to be supported at home. She is advocating for DSM 5 terminology for these two diagnostic areas eg Somatic Symptom Disorders

Very clear that CBT had weak evidence which may or may not shake up the psychosomatic psychologists/psychiatrists in NZ. Some of the somatic models quoted were developed by the current professor of the Dept of Psych Med, Otago Uni, so should be interesting to see discussion around this.