When Psychiatric Issues Cause Physical Ones

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Do you know what a "bezoar” is? Probably not, but you have likely heard the term "psychosomatic," which means an ailing mind can actually physically bother or impair your body.

Sometimes the primary disease is truly in your head, or at least it seems to have started there.

First, in answer to the question. A bezoar (1) is various masses of material that can't be digested - "calculi" - usually found in the gastrointestinal organs. As a result, it becomes like a rock in the body prompting mechanical obstruction and nutritional problems to occur.

In olden days, such a "bezoar stone" was considered to possess magical properties, especially if it came from animals. One belief was that they were mystical and could cure poisons. In the 16th century, the famous surgeon, Ambroise Paré, attempted to debunk the theory when he “tested” it on a convicted thief. The accused was given a toxin and then the bezoar. (2) The prisoner perished within hours.

Why write about it? There is a psychological belief about disease and then there are instances where psychology is directly implicated. While a bezoar can happen to diabetics or people who had abdominal surgery with anatomy changes (3), one type, trichobezoars (balls of hair or other fibers), tend to occur in those with psychological conditions, ranging from anorexia or obsessive-compulsive disorder to extreme emotional distress.

What the ancients called supernatural is to us evidence that the symptom is not always accurately mapped to the real disease (4). For example, people suffering from Trichotillomania have an intense impulse to pull out their hair - this results in bald, bloody patches in their scalp. This “Rapunzel Syndrome” often is linked to a trichobezoar since the afflicted may ingest their tresses.

A recent published case reported one made of fleece in a young girl. The anemic child arrived in the ER with belly pain that was exacerbated by food. The speculation is that the trigger was the birth of a new sibling because she was ingesting fleece lining from her boots and jackets, necessitating surgical removal and psychiatric follow-up care (5). This is quite a radical consequence of clearly complex stressors and warrants comprehensive long-term attention.

Did the behavior cause the bezoar or did the bezoar cause the behavior? This is not an uncommon paradigm in medicine. Patients with 'psychogenic polydipsia' - a clinical disorder seen typically on psychiatric wards - will drink water to intoxication levels thereby plummeting their sodium spurring on seizures, even psychosis and death. The etiology is unclear. In 'pseudocyesis,' the patient will demonstrate actual symptoms of pregnancy with one minor exception, the existence of a baby. More routinely, young otherwise healthy children as an act of defiance or in response to environmental stressors will exhibit stool withholding. This action can elicit a physical problem. These kids can become impacted and require urgent intervention.

I could go on and on about the correlation between the mind's influence on the body and the body's impact on the mind. Hmmm... maybe I will in my next piece. Keep reading!

SOURCES:

Merriam-Webster's Dictionary

Eng K, Kay M. Gastrointestinal Bezoars: History and Current Treatment Paradigms. Gastroenterology& Hepatology (NY). 2012;8(11):776-778.

Setya A, Mendoza L, Fagan D.  Fleece Bezoar in a 6-Year Old Girl.Consultant for Pediatricians.  2016;15(9):461-463.

NOTES:

(1) Though we talk about trichobezoars there are three others. Pharmacobezoars are consolidations of medicines which can cause complications from drug levels as well as physical restrictions. Lactobezoars contain milk protein. Phytobezoars are the most common containing plant-based matter, like fruits or veggies.

(2) Good luck getting that by the Independent Review Board today.

(3) And, strangely, those who eat a lot of persimmons.

(4) Sorry homeopaths.

(5)If it's not psychiatric in origin, and isn't at the extreme level of needing surgery, case studies have found that Coca-Cola has been used as a treatment in dissolving phytobezoars. Sometimes it takes tools administered with an endoscope.