Psychosomatic medicine: state of the art

Contemporary psychosomatic medicine must take into consideration developmen ts in psychobiology. The difficulty in accepting dualistic concepts is a se rious challenge to positions distinguishing between psychological and 'real ' causes of disease. There is more emphasis on life style factors for disea se and on the impact of psychosocial factors on illness rather than on dise ase. The neurophysiological concept of activation or arousal has been impor tant in the development of rational pathophysiological models that describe how sustained arousal may be a pathophysiological factor. For illness, sen sitization may be an acceptable psychobiological mechanism underlying very frequently occurring and expensive medical conditions that require medical and economical assistance. One possible alternative to old dynamic concepts is the development of a cognitive arousal theory of stress.