I was recently asked by a patient to explain psychosomatic symptoms. ￼ A psychosomatic illness originates from or is aggravated by emotional stress and manifests in the body as physical pain and other symptoms. Depression can also contribute to psychosomatic illness, especially when the body’s immune system has been weakened by severe and/or chronic stress. Symptoms that my patients have experienced include unexplained swelling and pain in feet or hands, difficulty moving limbs, neck and back pain and spasms, difficulty walking,￼ ￼￼and non-epileptic seizures, which used to be known as pseudo seizures.￼
A common misconception is that psychosomatic conditions are imaginary or “all in the head.” In reality, physical symptoms of psychosomatic conditions are real and require treatment just as any other illness. When you go to your doctor with physical symptoms, they will generally look first for a physical explanation for your pain, which may include physical examination, MRIs, and lab tests/bloodwork￼. If there is no obvious physical cause that they can easily test for, coming up with a diagnosis and plan of treatment may be complex.
One of the most hurtful thing for patients who experience somatic complaints is being told that their very real distress is not based on any actual facts.￼ When this happens, people might feel like their doctor is not taking their symptoms seriously, thinks the person is making it up (malingering), or that it’s “all in their head.” When your doctor can’t find a clear physical cause for your pain (such as an injury or an infection), they may ask you about how you feel emotionally. The hope is that if a source of stress can be identified, it can be treated (just as you would get treated for an injury or illness).
Symptoms caused by stress that you feel in your body are very REAL, they are just caused by a different mechanism that, say, if you broke a bone. For example, people with somatic, non-epileptic seizures, are often prohibited from driving￼. Your doctor may want you to talk to a mental health professional, but that’s not to say that your physical symptoms only need psychological treatment. It is important to learn how to effectively manage stress, but that is often a process and can take time. In the meantime, you need to treat your physical pain and other symptoms. For example, if you have severe pain in your neck or back, learning to cope with stressful triggers can certainly help prevent from happening—but the pain is not only in your mind. It’s entirely real.￼
While it might start in your brain, stress causes a cascade of neuro chemicals in your body that produces inflammation in the muscles of your neck, which in turn causes you pain. You may need anti-inflammatory medications, muscle relaxers, or another type of treatment, such as massage and physical therapy to manage your pain. The mind and body are inextricably and reciprocally interactive. ￼