Antecedent psychological factors in the onset of vasovagal syncope.

Broad psychosocial antecedents for 18 aviators with vasovagal syncope are compared with 31 controls. The immediate thoughts, fantasies, and feelings of the fainters are examined in detail. The fainters had significantly more job dissatisfaction than the controls. The presyncope fantasies of the fainters confirm Engel's observations of the immediate psychological context for vasovagal syncope (anticipation of bodily harm, denial of fear, and submission to a threat), and extend his formulation to include psychological harm in the form of humiliation, embarrassment, and loss of prestige.