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KMID : 0381219750070110753
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Journal of RIMSK
1975 Volume.7 No. 11 p.753 ~ p.771
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Psychosomatic Study for Etiology of Parametropathia Spastica( I )
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Abstract
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Parametropathia spastica, characterized by lower abdominal pain and pelvic pain by touch or stretching of cervix or uterosacral ligament or both tenderness without apparent causes, is a common and perplexing problem to the gynecologist. The purpose of this article is to establish psychosomatic explanation about this syndrome which must be explained by any theory of causation which must be permanently or provisionary adopted.
In this study, it was attempted to reveal the characteristic clinical picture and etiological evaluation of this syndrome in terms of age distribution, social history, marital history, family history, reproductive history, menstrual history, ´sexual history, gynecological symptoms, extragenital psychosomatic symptoms, psychiatric diagnosis, personality, psychological test, precipitating factory, psychodynamic factors, and other etiological considerations. The cases, consisted of 42 cases ranging in age from 20 to 54 years referred from the department of obst. & gynec. with the impression of parainetropathia spastica to the department of neuropsychiatry, Chung-Ang University Hospital and the weekly semistructured psychiatric interviews were conducted with all patients and the mean number of interviews were 17.0.
most of the accepted endocrine disorders were chiefly manifested. Their mean age was 39.5 years.
2. It was revealed that their socio-economico-educational level was relatively higher, their mean marital age was 24.4 years, their mean age interval with husband was 9.5 years, about one-half of the cases got married only by match-making,and most of them experienced marital disharmony, extramarital affairs or frequent absence of home by the spouse.
3. Either they or their husband represented, for the most part, the eldest of rather large families. They exhibited episode of unhappy early life, intrafamilial conflict, and poor interaction with their parents such as recent loss of parent, parental marital disorder, parental chronic invalidism, and unfavorable parental attitudes toward patients.
4. These cases show higher incidence of pregnancy rate, full term delivery rate, induced abortion rate, contraceptive rate and subsequent delivery rate, but relatively lower incidence of spontaneous abortion rate comparing with U.S. A. report(Taylor, Duncan study). They had been definitely unfavorable response toward the first pregnancy such as unwanted or anxious one and had been undergoing birth control chiefly by coital interruption.
5. Most of them observed changes in menstruation, and showed inadequate response toward original menstruation, and their mean age at menarche was 16.1.
6. It was revealed that this cases showed more sexual conflicts and much sexual interruptive factors such as extramarital affairs, premarital affairs, venereal disease, morning sex for the favorite time of coitus, sadomasochism, masturbation, decreased or loss of libido(frigidity, p´emature ejaculation, and impotence), excessive or frequent coitus, unpleasant feeling toward first coitus, and avoidance of sexual coitus, etc.
7. Among gynecological symptoms, lower abdominal pain was the principal cause and they also complained of low back pain, dyspareunia, premenstrual tension, leukorrhea, and secondary dysmenorrhea. More frequently encountered extragenital psychosomatic symptoms were nervous tension, insomnia, headache, phobic symptom, hypochondriasis, fatigue, depressive symptom, behavior disorder, cardiac symptoms, or emotional instability. In the psychiatric states, n o,t of this cases were diagnosed as neurosis or depression, their premorbid personality :gas the passive aggressive and hysterical one and these cases shows also similar MMPI findings comparing with that of Korean psychophysiological disorders.
8. As the result of extensive psychosomatic analysis of the exact psychological background and the relationship of alterations in pelvic circulation to life situations and emotions, it was revealed that the following characteristic 4 categorries were presumed causative psychodynamic factor; of parametropathia spastica in Korea.
A. Various factors to threaten feminine biological function such as parturition, abortion, contraception, sexual conflicts and familial trouble - anxiety, fear - anxiety neurosis or pelvic autonomic dysfunction.
B. The passive aggressive personality - aggression, hostility, chronic rage - depression or sympathetic nerve dysfunction - cardiovascular neuromuscular disorders or pelvic autonomic dysfunction.
C. The hysterical personality - infantile dependency, inferiority feeling - conversion hysteria or parasympathetic nerve system dysfunction - gastro-enterocolic disorders or pelvicc autonomic dysfunction.
D. The obsessive or depressive personality -shame, guilt - object loss - mourning - depression or hypersensitivity of pain center due to self-punishment - pelvic autonomic dysfunction. On the basis of these psychiatric status including above mentioned psychodynamic factor, psychosomatic symptoms, premorbid personalities and MMPI findings, it is postulated that the parametropathia spastica is also a psychophysiological disorders
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