Article summary with Subjective health complaints, sensitization, and sustained cognitive activation (stress) by Eriksen & Ursin - 2004

What is somatization?

In the ICD 10, somatization is defined as the constant presentation of symptoms that require investigation. There is no physical basis for these symptoms, nor a medical explanation. The most common complaints are muscle pain, pseudoneurology and vague unspecific gastrointestinal problems. Pseudoneurology includes fatigue, sleep problems and changes in mood. The complaints lead to many days of illness and visits to the doctor. Nowadays, the complaints are sometimes diagnosed as burnout, stress or irritable bowel syndrome.

What is sensitization?

The complaints that people have with somatization appear to be based on being oversensitive to sensations that signal normal physiological processes. In some people, these become conditions that cannot be tolerated. The psychological mechanism underlying the differences in tolerating and accepting common health complaints could be sensitization. Sensitization means that repeated stimulation can lead to an increased response. This is the opposite of habituation, in which getting used to a certain type of stimulation leads to a reduced response. Sensitization can occur at the cellular level as well as at the psychological and interpersonal level. Sensitization causes people to be more vulnerable to sensations from the limbic system. Next, sensitization also leads to increased attention for symptoms and a cognitive bias. Sensitization can be caused by strong unpredictable stimulation. When a person is very stressed, the effect of sensitization is greater.

Sensitization at high cognitive levels resembles attentional bias or cognitive bias. This is also known as cognitive emotional sensation. All attention is drawn to the information that contains matters of concern to the person. For example, anxious individuals prioritize cognitive processing of anxiety-related information.

What is the cognitive activation theory?

How big a person their stress response is depends on what was learned about a situation earlier. According to the cognitive activation theory the brain makes connections between stimuli or responses and their outcome. A connection between a stimulus and its outcome is known as classical conditioning, whereas a connection between a response and its outcome is known as instrumental conditioning.

When a person has previously had success in a certain situation, they also have positive expectations and coping. However, when a person has failed before in a situation, it leads to failure expectations. Not experiencing a relationship between an action and an outcome leads to an expectation of helplessness. A person who has learned that all actions lead to failure has an expectation of hopelessness. This can lead to increased stress levels and (psycho)pathology.