Functional cardiac complaints arise on the basis of complex interactions between biological, psychological, social and iatrogenic factors:
The trigger is usually a stressful life event such as separation, loss of partner, professional crisis, etc.
- Increased psychological vulnerability:
Exploration often reveals serious biographical stress factors that impair maturation of physical resilience such as: Neglect, abuse, etc.
- Restriction of affect regulation:
Denial of the connection with the trigger and symptomatology is typical of functional cardiac complaints.
- Cognitive misattribution:
The physical symptoms are physically misvalued by social experiences such as parents' heart disease, own physical diseases, etc.
- Somatosensory amplification:
The patient tends to perceive normal- physiological phenomena such as palpitations amplified, which ultimately activates a vicious cycle of anxiety.
- Neurobiological activation of pain experience:
Pain perception is tied to complex cognitive and emotional processes and is always subjective. Thus, negative emotions can be augmented into a sensation of pain by otherwise subliminal somatosensory stimuli.
To avoid the distressing symptoms, physical sparing behavior often occurs. This favors the onset of symptoms during mild physical exertion and creates a vicious circle.
Iatrogenic factors can contribute significantly to the chronification of the condition, such as cardiological medication of convenience, uncritical multiple diagnoses, hasty sick leave or recommendation for retirement, but also premature or inappropriate confrontation with the functional genesis of the disease.
(Marx 2022)