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Factors Related to the Localisation of Symptoms to the Chest in Depression

Over a hundred years ago Griesinger (1861) identified hypochondriasis with melancholia; and quite recently, Kenyon (1964) in a study of 512 patients with a diagnosis of hypochondriasis concluded that it was always part of another syndrome, most commonly a depressive or anxiety state. Many patients with a depressive illness experience localized somatic symptoms. The question arises why, during an episode of depression, some patients have localized somatic symptoms, sometimes consistently in the same site in recurrent episodes, whilst others have none. The head, chest and abdomen have been reported as the most common sites (Schneider, 1959; Gittleson, 1962). Jaspers (1913–46) pointed out that ‘we should distinguish between phenomenological description of actual bodily experiences and any discussion of the significance for the individual of his own body in terms of the effective meaningful connections where there are hypochondriacal narcissistic or symbol-forming tendencies influencing the self-awareness'. The present study is concerned with the possible meaningful connections related to the localization of symptoms to the chest in depression, and follows a descriptive account of respiratory symptoms in depression (Burns, 1971). These symptoms include sighing respiration, hyperventilation, ‘vital feelings' on the chest and depressive delusions directed towards the chest.