Some patients experience untoward idiosyncratic reactions when they eat certain wholesome foods. Such illness may be caused by psychogenic or allergenic mechanisms, or by both. The relative importance of psychogenic and allergenic factors in the production and continuance of food-induced illness must be estimated correctly in order to plan a correct program of therapy.
This paper reports some of my experiences with the treatment of about 600 patients (seen in the past ten years) who had certain food-induced syndromes, with or without associated primary neuropsychiatric disturbances.
Foods become endowed with various dynamic emotional meanings according to the person's upbringing, cultural and religious training, and personal life experiences.
Psychogenic food reactions may include anger, anxiety, anorexia, depression, euphoria, feelings of security, guilt, hostility, passive-dependent attitudes, pleasure, syncope, and relaxation. The most common untoward idiosyncratic psychosomatic reactions to food include nausea, vomiting, epigastric discomfort or pain, intestinal cramps, aerophagia, belching, and rarely diarrhea--all being part of the riddance reaction.
The symbolic supportive values of certain foods are such that a person may overeat these foods when he is subjected to unusual emotional stresses. Such categories of foods include the "security," "reward," and "pleasurable association", foods. An individual may eat excessive amounts of these foods during times of emotional stress, even though they may be the very ones which produce his allergic illness.
The fixed food allergy is very well known, but relatively uncommon. The variable food allergy is very common, but not very well known.
In the variable food allergy, tolerance for a given food may vary so that at some times small amounts of the offending food will cause an allergic reaction. But at other times the amount of this food which must be ingested to cause an allergic reaction may be very much greater than any amount that the patient would ordinarily eat.
Allergic reactions following the ingestion of offending foods have certain characteristics: there is a latent period between ingestion of the food and the appearance of signs and symptoms; the allergic syndrome has a certain pattern of development and regression of signs and symptoms; it has intensity and duration. These properties in part determine the nature of allergic reactions to repeated ingestion of subthreshold and threshold doses of offending foods.
With brief postcibal allergic reactions, each ingestion of a threshold dose of offending food is followed by a discrete reaction. Usually there is no summation of subclinical effects produced by ingestion of repeated subthreshold doses.
Repeated daily ingestion of threshold doses of foods which give prolonged postcibal allergic reactions will cause a clinical pattern of allergic reaction resulting from summation, fusion, and adaptation to each individual allergic insult, until finally many patients may develop a steady state of allergic reaction. The daily ingestion of subthreshold doses of such foods is capable of causing a clinically obvious allergic reaction through virtual summation of clinically inapparent allergic reactions caused by ingestion of each subthreshold dose.
Each primary allergic reaction set off by ingestion of an unknown allergenic food actuates a secondary postnoxious pattern of behavior which becomes an important part of the patient's reaction to the offending food. But if a patient knows he is eating an allergenic food which will make him sick in a specific way, he does not develop the secondary postnoxious behavior pattern. Recurrent episodes of spontaneous food-induced allergic illness occurring at unpredictable intervals cause certain patterns of conditioned responses in humans. Not knowing when he will be well or sick acts as a frustrating cue, in response to which a patient develops the human counterpart of the non-problem-solving behavior described by Maier for frustrated rats. These secondary reaction patterns of behavior often become so prominent and extensive a part of the patient's complaints to the doctor that even an astute allergist at first glance may consider mistakenly that the patient's problems are purely psychiatric. But further careful clinical study of such a patient will show that he is experiencing a primary allergic reaction to an offending food, which in turn sets off a chain of behavior patterns which are the patient's unconscious response to his allergic illness. Sometimes the secondary behavior patterns engendered by intermittent allergic episodes may become so incapacitating to the patient that they constitute his chief health problem.
The food-induced allergic mental, fatigue, and pain syndromes are described. These may occur singly or in any combination, and may be associated with any other allergic syndromes. The patient's response to combined allergic and psychological therapy is illustrated by three case reports.
As a result of psychotherapy alone, a patient may unconsciously modify his diet so that he includes less of the security, reward, and pleasurable association foods. If he is also allergic to these foods, he will have a remission in his illness as an indirect consequence of psychotherapy.
Many patients are relieved of allergic ill health when they abstain from known offending foods. However, some of these patients will have conscious or unconscious needs at certain times to eat allergenic foods which they know will make them sick. The subtle nature of food-induced self-injury readily escapes the attention of the patient's family and friends--and even, sometimes, of his unsuspecting physician. Self-inflicted, food-induced allergic illness can become a recurrent problem until the physician can understand the basic psychodynamics of such self-injurious behavior, and can then help the patient to make better adjustments to life problems.
The best management of all patients with food allergies requires both expert allergic therapy and expert psychotherapy.
Received March 26, 1952
Copyright © 1954 by American Psychosomatic Society