BEHAVIOR: CAUSE OF PHYSICAL PROBLEMS?

Dennis B. Kottler, MD

Westlake Village, CA

Appointments: 818-991-8376

CAUTION: The reader is advised to AVOID SELF-DIAGNOSIS. Many of these conditions can have more than one possible cause and therefore consultation and treatment by a physician is imperative.

Consider the following:

A young man visits his dermatologist. He has developed a nasty rash on his hands. He is told he has "eczema" and is prescribed a cortisone ointment to be applied several times a day. The rash does not heal. Sometimes it bleeds and sometimes it looks infected, with pustules. The young man is getting increasingly frustrated until he reads an interesting article entitled: "Hot Water Eczema: A Problem for Obsessive-Compulsive Hand Washers."

The young man researches the "net" and learns all about Obsessive Compulsive Disorder and decides he probably has this condition. The rash has resulted from excessive hand washing, particularly in hot water. After consultation with a psychiatrist and a course of treatment for the OCD, the condition has disappeared!

***TECHNICAL SIDEBAR: As the rash got worse, there was a tendency for the young man to keep his hands under the hot water longer and longer, since the hot water felt good. Little did the youth realize that this action was worsening the condition by washing away the natural oils in the skin, leading to further drying, cracking, and infection.

Not all examples of behaviorally-induced physical problems are so clear-cut. The conditions below are divided into those with a direct behavioral cause and those where there is probably a behavioral connection:

Direct Behavioral Cause

1 -- TRICHOTILLOMANIA (Hair loss due to pulling): This condition is an OCD Spectrum Disorder and it leads to various degrees of balding due to the incessant plucking of hair. Hair may be pulled from the head, eyebrows, eyelashes, and even the pubic area. The person usually tries to resist the behavior but finds this nearly impossible. The hair plucking sometimes follows a careful ritual wherein the hair is gently teased out with minimal pain, visually inspected, twirled between the fingers, sometimes mouthed or the root bitten off, and then discarded.

Treatment: Psychiatric consultation followed by medication, behavioral treatment, and stress reduction.

2 -- TIC DISORDER - Motor and/or phonic - (sometimes with sore and/or hypertrophied muscles): This problem can also be part of an OCD Spectrum Disorder.

Treatment: Psychiatric consultation followed by medication, behavioral treatment, and stress reduction.

3 -- EROSION OF TOOTH ENAMEL/PAROTID GLAND ENLARGEMENT, etc: These conditions can be the consequence of the binge/purge disorder, bulimia. The frequent regurgitation of stomach contents, including hydrochloric acid, has a corrosive effect on the enamel of the teeth. This is often first seen on the inside (lingual) surfaces of the teeth.

Treatment: Psychiatric consultation followed by medication and behavioral treatment.

4 -- CHRONIC CONSTIPATION: This condition can be caused by the use of constipating OTC medications such as sleep aids containing antihistamines. Prescription medications can also be a factor.

Treatment: Medical/Psychiatric consultation to evaluate the underlying cause of the sleep disorder.

5 -- TRAUMA OF VARIOUS SORTS, including cigarette burns, lacerations, incisions, puncture wounds, excoriations, broken hands, etc., all of which may be SELF-INFLICTED.

Treatment: Medical and then psychiatric intervention if appropriate.

6 -- EMPHYSEMA/LUNG CANCER: Frequently, but not always, the consequence of smoking. Incidence increases with pack-years, although some individuals are prone to earlier and more aggressive forms of these diseases.

Treatment: Smoking cessation therapy//Medical treatment.

7 -- LIP/THROAT CANCER: Related to smoking cigars, pipes, and cigarettes.

Treatment: Smoking cessation therapy//Medical treatment.

8 -- OBESITY: Various psychiatric conditions, including anxiety and depression may contribute.

Treatment: Medical/Psychiatric consultation.

9 -- UROLOGICAL DISORDERS: Various urological disorders can be traced to SEXUAL behavior. These include such obvious problems as sexually transmitted diseases as well as less obvious problems, such as "honeymoon" cystitis in the female, "'prostatitis" in the male, and a number of physical irritations and injuries resulting from particular sexual practices.

Treatment: Medical/Psychiatric consultation.

Probable Behavioral Connection

1 -- TMJ (Temporomandibular joint disorder): In this condition there is pain and discomfort in the area of the temporomandibular joint, where the condyle of the mandible (lower jaw) articulates with the glenoid fossa (a notch in the temporal bone of the skull). This discomfort can radiate to remote areas of the head, causing fullness in the ears, headache, even upper back and neck pain. There may be discomfort opening the mouth and chewing.

Probable behavioral factors include clenching and grinding the teeth (bruxism), often during the night, which may be associated with generalized anxiety disorder or repressed anger. Other behavioral factors involve activities which may stress this joint. This can range from an improper or ill fitting scuba mouthpiece (!) to the compulsive cracking of the jaw...found in some individuals with OCD.

Treatment: Dental consultation and psychiatric referral if appropriate.

2 -- HYPERTENSION: Most cases of hypertension (elevated blood pressure) are of unknown cause (Essential Hypertension). However, there are cases where hypertension can be transient and quite labile. In these cases psychiatric and behavioral factors make a significant contribution. Angry outbursts as well as emotional stress from various causes (even the doctor visit itself: "white coat syndrome") are frequent factors to consider.

Treatment: All cases of hypertension must be evaluated by a physician to prevent additional harm.

3 -- ARTERIOSCLEROTIC CARDIOVASCULAR DISEASE: Probable risk factors are SEDENTARY lifestyle, SMOKING, STRESS, TYPE "A" PERSONALITY, POOR DIET, OBESITY.