Negative affect states and cardiovascular disorders: a review and the proposal of a unifying biopsychosocial concept

Aim: The purpose of this review was to study the relationships between negative affect states and cardiovascular disorders. Procedure: The phenomenology of the negative affect states of depression, helplessness, hopelessness, vital exhaustion and grief is described. Their correlations with morbidity and mortality are analyzed. The physiological correlates of the affect states are pointed out. Finally, the reaction pattern of conservation-withdrawal according to Schmale [Psychosom. Med. 20 (1958) 259-277] and Engel [Internat. J Psychoanalysis 43 (1962) 89-97] and its ontogenesis are outlined. This is a disengaging behavior pattern as opposed to the engaging fight-flight reaction pattern of Cannon [Psychosom. Med. 19 (1957) 182-190]. The giving up complex, with its affects of helplessness and hopelessness, is explained. Conclusions: The giving up complex in the context of the conservation-withdrawal pattern presents a biologically and developmentally sound conceptual basis for the understanding of the relationships of the negative affect states with cardiovascular disorders. This enables the integration of the concept of vital exhaustion, which has become the most promising operationalized instrument in psychosocial cardiovascular research. (c) 2005 Elsevier Inc. All rights reserved.