Psychosomatics by Irina Germanovna Malkina-Pykh

Irina Germanovna Malkina-Pykh is a domestic psychologist and practicing specialist. Her book “Psychosomatics” is written in a popular science language, suitable for psychology students, consultants, psychotherapists, and anyone interested in psychosomatics. This book is both theoretical and practical, describing general and specific examples of psychosomatic illnesses, their causes, and methods of diagnosis and treatment.

General Psychosomatics

Psychosomatics is an applied branch of clinical psychology studying the psychological causes of diseases, exploring how stress affects bodily functions. Simplified, the development mechanism of a psychosomatic illness involves certain weak spots in a person (organs, systems), termed ‘somatic readiness’ by Freud. When defense mechanisms protect the psyche from trauma, CNS impulses are redirected to the autonomic nervous system, affecting vulnerable organs. Factors such as emotional characteristics, life experience, and nervous constitution also play a role.

Factors in the development of psychosomatic diseases include:

  • Heredity, genetic predisposition.
  • Congenital somatic defects.
  • Disturbed neurodynamics.
  • Personality traits.
  • Mental and physical state at the time of psychological trauma.
  • Characteristics of the social development situation.
  • Nature of the traumatizing event.
  • Age at which the trauma occurred.

Important! Psychosomatics is an interdisciplinary field, combining medicine and psychology, hence the diagnosis and treatment of psychosomatic diseases should be comprehensive.

Diagnosis in Psychosomatics

The root of psychosomatic problems lies in suppressed or denied emotions and experiences, internal conflict, usually at a subconscious level. To find the true cause of illness, discussions, tests, and projective techniques are used.


During a discussion, it’s essential to determine the patient’s current state by answering questions about their knowledge of the disease, its significance now and in life, whether they believe they are responsible for their condition, and if their views match the psychotherapeutic assessment. It’s crucial to know the patient’s life history, including hereditary factors, past illnesses, coping mechanisms, personal views on the problem, and emotional support.

A casual conversation setting is needed for the patient to fully open up and detail their psychological trauma. The discussion should cover:

  • Patient complaints.
  • Symptoms of the disease.
  • When symptoms appeared.
  • The situation at the onset of the illness.
  • Current life situation.
  • Patient’s life history.
  • Personality traits and internal conflicts.

Interesting! You can learn more about the conduct of discussions and other diagnostic methods in Malkina-Pykh’s book “Psychosomatics.” Her books “Age Crises” and “Extreme Situations” are also recommended.


Tests help to understand a person’s psychotype, stress responses, character accentuations, the presence of depression or other personality disorders. Malkina-Pykh suggests using several techniques, including the Toronto Alexithymia Scale, Gießen Complaint Questionnaire, Spielberg-Hanin Reactive and Personal Anxiety Scale, Serdyuk’s Questionnaire for studying the social significance of illness, Sachs-Sydney Incomplete Sentences Method adapted for psychosomatic patients, and others. The book provides detailed descriptions, forms, and questions for these tests.

Projective Techniques

Projective tests reveal personality traits and the client’s state, based on associations and projections. Clients view abstract shapes, spots, drawings, with the Rorschach test being the most popular. These tests provide access to the subconscious, revealing suppressed or denied aspects.

Psychotherapy for Psychosomatic Diseases

Psychotherapy involves verbal and non-verbal communication with the client, aimed at eliminating symptoms and causes of illness. Emotional tension can be caused by internal conflict, benefits of illness, life script, self-suggestion, self-punishment, psychotraumas, alexithymia. Various types of psychotherapy can be used, including self-suggestion and hypnosis, solution-focused therapy, positive psychotherapy, cognitive-behavioral therapy, symboldrama, transactional analysis, art therapy, creative visualization, psychodrama, dance-movement therapy, body-oriented psychotherapy, family psychotherapy, psychosynthesis, gestalt therapy, and NLP (neuro-linguistic programming).

Interesting! Psychosomatic illness can result from “organic speech,” where expressions like “my heart aches for him” or “it drives me crazy” can turn into an internal program.

Private Psychosomatics by Irina Germanovna Malkina-Pykh

The book by Irina Germanovna Malkina-Pykh delves into private psychosomatics, exploring the specific connections between organs and emotions. It identifies five common meanings behind illnesses: escaping problematic situations, a primitive way to gain attention and care, prevention of burnout, a stimulus for reevaluating beliefs and lifestyles, and a socially approved form of protest against external demands. The book reveals that psychosomatic illnesses often serve hidden benefits for the patient, meeting their needs in unconventional ways.

Respiratory Diseases

Psychosomatic respiratory diseases include bronchial asthma and hyperventilation syndrome, often arising in people with phobias or those whose desires are constantly suppressed, reflecting an inability to “breathe freely” and a sign of non-viability.

Cardiovascular Diseases

Psychosomatic cardiovascular diseases include hypertension, ischemia, myocardial infarction, and cardiophobic neurosis. They are often caused by feelings of uncertainty, emotional exhaustion, and suppressed hostility.

Psychosomatics of Eating Behavior

Psychosomatic eating disorders include anorexia, bulimia, and obesity. Overeating is linked to unmet needs for safety, love, and protection. Bulimia reflects ambivalent feelings towards the mother, while anorexia represents a struggle for control and independence or fear of sexuality.

Interesting! Malkina-Pykh’s book “Therapy of Eating Behavior” offers in-depth insights into eating disorders and their treatment.

Gastrointestinal Diseases

Psychosomatic gastrointestinal diseases include stomach and duodenal ulcers, constipation, diarrhea, colitis, Crohn’s disease, and swallowing disorders. They result from fear, aggression, apprehension, insecurity, and depression, reflecting the inability to “swallow” or “digest” life experiences.

Endocrine System Diseases

Stress-induced endocrine disorders include hypothyroidism, hyperthyroidism, and diabetes, often resulting from life passivity, aversion to routines, and conflicts between desires and duties.

Skin Diseases

Skin diseases symbolize an attempt to shield oneself from societal pressures, indicating a need for emotional protection against violence and aggression.

Gynecological Diseases

Psychosomatic gynecological diseases include uterine extirpation, breast cancer, dysmenorrhea, PMS, pseudopregnancy, functional disturbances in the hypogastrium, and functional sterility. They often indicate problems in partner relationships or stem from a rejection of one’s body and sexuality, or as a response to experienced violence.

Musculoskeletal Diseases

Psychosomatic musculoskeletal diseases include fibromyalgia, osteochondrosis, arthritis, rheumatism, and intervertebral hernias, often arising from internal personality contradictions or the inability to bear life’s burdens.

Psychovegetative Syndromes

Caused by overexertion, life dissatisfaction, and circumstantial pressures, psychovegetative syndromes result from constant stress and disrupted sleep patterns.

Functional Sexual Disorders

Functional sexual disorders, often a defense mechanism, arise from interpersonal conflicts and are associated with fear and complexes.

Oncological Diseases

Cancer’s psychosomatic causes include loss of a loved one, unresolved psychological ties, suppressed emotions, and feelings of guilt and resentment.

Psychosomatic Aspects of Depression

Depression can develop from prolonged stress, exhaustion, and anxiety. Often resembling endogenous depression, it is typically preceded by separation, isolation, and increased responsibility.

Infectious Diseases

Infectious diseases stem from internal or external conflicts, as evident in symptoms like colds, coughs, sore throats, and general malaise, reflecting an inability to process life’s minor details and a desire for attention and care.


Headaches often result from situational difficulties and conflicts, suppressed resentment and anger, and are common in people who cannot progress or please others as desired.

Important! The issues discussed can manifest as independent psychosomatic illnesses or symptoms of other disorders. They may occur individually or collectively, and there are many possible causes. Accurate diagnosis and treatment selection require considering the individual’s personality traits, lifestyle, and development situation.

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