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April 1967

Symptom Alternation: An Evaluation of the Theory

Author Affiliations

New York
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, Columbia Psychoanalytic Clinic, and the Vanderbilt Clinic (Dr. O'Connor), and the Department of Pediatric Psychiatry, Babies Hospital, Columbia Presbyterian Medical Center, New York (Mrs. Stem).

Arch Gen Psychiatry. 1967;16(4):432-436. doi:10.1001/archpsyc.1967.01730220044007

THE THEORY of "symptom alternation" has achieved a considerable degree of acceptance in both the fields of psychiatry and medicine. It can be defined as a substitutive phenomenon in which one set of symptoms or one disease process is exchanged for another. Essentially, there are three forms of symptom alternation: (1) substitution of psychologic for physical symptoms; (2) substitution of physical for psychologic symptoms; or (3) substitution of one physical symptom for another.

This study deals with the concept that physical and psychologic symptoms are interchangeable—specifically, that somatic disease can be replaced by a psychosis, or conversely, that a psychosis can be replaced by physical symptoms. The theory is an attractive one with dramatic impact, and tends to coincide with other psychopathologic hypotheses. However, the majority of reports in the literature cite only isolated cases or refer to a sample so small that sta