THE SIGNIFICANCE OF SYNDROME SHIFT AND LATE SYNDROME ASSOCIATION IN PSYCHOSOMATIC MEDICINE

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Abstract
An outline is given of the psychosomatic phenomena of syndrome shift and late syndrome association, and the possible psychodynamics are discussed. The occurrence of these phenomena postulates the existence of a psychosomatic group of disorders, but such a group is not universally accepted, especially in the United States. The following considerations are presented to justify the recognition of such a group: 1) Statistical evidence of late syndrome association in patients with pulmonary tuberculosis. 2) Statistical evidence of a more frequent family history of psychosomatic disorders among patients with psychosomatic disorders. 3) Sainsbury''s statistical eivdence of differences between patients with and without psychosomatic disorders in regard to two traits, extra-version and neuroticism, in a Maudsley Personality Inventory study. 4) The recognition by Halliday of six criteria, other than "associations with other psychosomatic affections," distinguishing a psychosomatic group of disorders. 5) The rationale of Halliday''s justification of his concept. The importance to preventive medicine is stressed of recognizing groups at special risk for the development of certain disorders of psychosomatic importance, some of which may be fatal. The recognition of a group of psychosomatic disorders is not at variance with other current viewpoints, such as those which emphasize the psychosomatic disease. Attention is drawn to the existing confusion in basic terminology and a plea made for international discussion and agreement on fundamental definitions and principles.