Some mistakenly suggest psychological causes, but most if not all women experience secondary psychological effects (e.g.: frustration, feelings of helplessness, isolation, depression, etc.) due to the misery and stress of HG. These emotions are well-documented in women on bed rest for non-hyperemesis causes. Unfortunately, studies of this nature have been cited for many decades, despite the poor study quality and lack of conclusive results. HG is a poorly understood disorder and as a result is often blamed on psychological causes because a physiological cause is still unknown.
Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum.
School of Social Work, Rutgers, The State University of New Jersey, New Brunswick 08901, USA. (e-mail: firstname.lastname@example.org)
Social Science & Medicine 2002 Oct;55(7):1267-78
Women's somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for women's health care and HG, in particular, are presented.
Psychological factors and hyperemesis gravidarum.
Simpson SW, Goodwin TM, Robins SB, Rizzo AA, Howes RA, Buckwalter DK, Buckwalter JG.
Graduate School of Psychology at Fuller Theological Seminary, Pasadena, California, USA.
Journal of Womens Health and Gender Based Medicine 2001 Jun;10(5):471-7
Hyperemesis gravidarum (HG) is a condition of severe, intractable nausea and vomiting during pregnancy. It has long been held that HG is a psychosomatic illness reflective of a long-term psychological trait, that is, conversion disorder. We investigated this possibility by conducting a two-phase study: (1) a comparison of women with (n = 9) and without (n = 10) HG during pregnancy and (2) a comparison of nonpregnant women who did (n = 10) and did not (n = 12) have HG during their most recent pregnancies. The pattern of findings differed between experiments 1 and 2. During pregnancy, women with HG scored significantly higher on three scales associated with conversion disorder (all p values <0.01) than did women without HG. There were no significant differences between HG subjects and controls after pregnancy. We find no support for the theory that HG is a psychosomatic condition. Rather, it appears to be a complex interaction of biological, psychological, and sociocultural factors.
A qualitative analysis of physician humanism: women's experiences with hyperemesis gravidarum.
Journal of Perinatology. 2000 Dec;20(8 Pt 1):540-7.
Patient satisfaction was associated with women's perceptions that physicians believed their accounts of their symptoms (i.e., that the woman is neither fabricating symptoms nor overreacting). The perception of being believed by doctors (and other health care providers) was important in terms of feeling validated that their illness was "real," and imperative to women seeking and receiving medical care. Perceived delays in diagnosing and/or instituting treatment were viewed as contributing to unnecessary exacerbations of the illness and hospitalizations, increased emotional strain, and psychological stress. This study highlights the importance of physicians "believing a patient's story" in contributing to patient satisfaction and possibly health outcomes.
Updated on: Apr. 18, 2013