Psychosomatic Medicine 15:61-65 (1953)
© 1953 American Psychosomatic Society

Raynaud's Disease

Psychogenic Factors and Psychotherapy

¹ Columbia Psychoanalytic Clinic for Training and Research, Division of Services to Medical Patients, and the Peripheral Vascular Clinic, Vanderbilt Clinic, Columbia-Presbyterian Medical Center, New York, N. Y.

Psychogenic factors play a predominant role in Raynaud's disease.

The attacks of vasospasm usually resemble anxiety attacks and are brought on by guilt over repressed resentment or sexual strivings, with a consequent fear of retribution. The conflict may be activated by actual or anticipated abandonment (death, illness, or loss of financial security), actual rejection (condemnation), or frustrated attempts at overcoming rivals.

The syndrome may occur in a variety of personality types but is most closely associated with the hysterical component in the personality and with obsessive-compulsive attempts at control of forbidden impulses.

The attacks are overdetermined psychodynamically, but one of the most striking mechanisms to be found is identification with a dead person toward whom strongly ambivalent feelings have existed.

Raynaud's disease responds well to psychotherapy--provided problems of anxiety, self-esteem, and guilt are approached first--when the patient's environment does not offer insurmountable obstacles and when there is as yet no irreversible tissue pathology.