Psicosomática y adolescencia: Hacia un modelo biopsicosocial integrador

Abstract

Este trabajo se propone argumentar un modelo biopsicosocial integrador de la psicosomática en la adolescencia, mediante una metodología de revisión teórica. Se utilizará como constructo articulador el modelo biopsicosocial de Engel (1977), desde una perspectiva subjetiva de la producción de síntomas. En la lectura actualizada de Borrel I Carrió (2002), es indispensable pensar los factores biopsicosociales desde causalidades circulares y estructurales. La causalidad circular sugiere la multiplicidad de factores presentes en un padecimiento y la causalidad estructural indica jerarquías entre factores. Este modelo biopsicosocial de lo psicosomático se sostiene en tres niveles: a) la revisión narrativa de diversos modelos teóricos; b) el análisis de la adolescencia como etapa del desarrollo psicosocial, y c) la revisión panorámica de un grupo de estudios empíricos. Esta propuesta destaca la importancia de construir un modelo integrativo de lo psicosomático que considere la circularidad de los síntomas y las estructuras jerárquicas implicadas en su análisis.

Adolescence is a very important stage. Many psychological conflicts appear at this time of life. Several biological characteristics are defined in this period. Teenagers have to adapt to many social changes. All these changes have psychosomatic effects. This theoretical work aims to present an integrative biopsychosocial model for the approach of psychosomatics in adolescence. Engel’s biopsychosocial model (1977) will be used as an integrating construct, which allows a broad perspective to address the condition, and places the subjective perspective involved in the production of symptoms at the center. It will be taken the updated proposal of Borrel I Carrió (2002) that points out the need to think about biopsychosocial factors from circular and structural causalities. Circular causality refers to relationships between different dimensions without analyzing the greater or lesser importance of these dimensions. On the other hand structural causality is aimed at analyzing which concept or category has a greater predominance or hierarchy in the process of producing symptoms. The authors also propose to support this biopsychosocial model of psychosomatic in adolescence from three levels. A first theoretical level, where a theoretical synthesis will be offered through the narrative review of the selected conceptual perspectives, such as: a) the emotions perspectives (Sánchez-García, 2013); b) the biopsychosocial model (Allen & Woolfolk, 2006) pertaining to cognitive-behavioral and affective therapy; c) some contributions from the Paris Psychosomatic School (Marty et al, 1968); d) concepts belonging to the Chicago Psychosomatic School (Alexander, 1950; Dumbars, 1943); e) positions from the field of stress studies (Brosschot et al., 2005; Kobasa, 1979); f) proposals in the psychosomatic approach of Donald Winnicott (1965), and g) concepts corresponding to the psychosomatic family model of systemic family therapy (Minuchin & Fischman, 1979; Onnis, 1990). A second instance will support the biopsychosocial model through an extract of elements present in adolescence as a stage of development, in which the biopsychosocial character of the multidimensional changes of this period will be visualized. In a third moment, through a panoramic review, a group of empirical studies from the last five years will be visualized, highlighting the need for a biopsychosocial model in the integrative approach to psychosomatics in adolescence. From a theoretical point of view, the need to take into account the complex articulation of different perspectives on biopsychosocial dimensions involved in the production of symptoms is corroborated. It is also verified that adolescence is a stage of multiple biological, psychological and social changes, and that the complex and contradictory nature of this period is of paramount importance in the appearance of symptoms in the body. Depending on each theory and its fundamental concepts, some categories will have greater explanatory power than others, but a comprehensive view requires different concepts to be related. Finally, the different empirical studies of the selected period justify the need to build a biopsychosocial model of the symptoms, which takes personality, family context, interpersonal relationships and comorbidity processes as fundamental categorical axes. At the three levels of support of the model (theoretical, stage of development and empirical studies), the need to understand psychosomatic manifestations through the interaction of the circular and the structural causes in the production of symptoms was demonstrated. A biopsychosocial model of the psychosomatic that tries to integrate contributions from different schools and empirical studies requires flexibility in the theoretical discussion and organization in the establishment of categories for understanding the symptom in the global structure of the subject. Adolescence as a stage of psychic development requires, from its complexity, an integrative approach that avoids the exclusion of theories in which there are important spaces of compatibility, and collect the largest number of empirical studies