The mind and body are connected in diverse ways. While, we often view them as independent in function, this is misguided. the body impacts the mind and the mind alters the body. For centuries, many professionals disregarded psychosomatic complains as the simple imaginations of a diseased mind. Doctors’ dismissed illnesses as the product of a neurotic imagination. As we move into new scientific frontiers, we are beginning to realize that perhaps we were a little hasty to disregard the complaints. Whether or not there is an identifiable organic cause to the pain, the life disruption is real and treatments available. Psychosomatic disorders impact 5-7% of the population. A closer look at the disease is imperative for the overall wellness, not only for those inflicted but also for those living with or around someone suffering from the disorder.
We call disorders that are not attributable to organic causes psychosomatic disorders (or somatoform disorders). Psychosomatic disorders frustrate victims as well as medical practitioners. Because the allusiveness of the cause, a treatment plan is difficult to implement. Annually, insurance and individuals spend billions of dollars searching for a cause to invisible illnesses, only to repeatedly receive negative results from the costly tests and examinations. Integrative medicine is having some success in treating these diseases. Others find relief through psychological approaches. We have effective avenues for treatment; but doctors and therapists can only administer these treatments once they correctly identify the illness as having a psychosomatic origin.
Key Definition:
Psychosomatic disorder is a psychological condition involving the occurrence of physical symptoms, usually lacking a medical explanation.
DSM-V Criteria for Psychosomatic Disorders
The American Psychiatric Association includes psychosomatic disorders in the Diagnostic and Statistical Manual of Mental Disorders. They provide the following criteria for diagnoses of psychosomatic disorders.
Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
- Persistently high level of anxiety about health or symptoms.
- Excessive time and energy devoted to these symptoms or health concerns (DSM-V-TR).
A term previously the lay population commonly used to describe psychosomatic disorders was hypochondria. However, because of the negative connotations associated with hypochondriacs the word has fallen from grace and seldom used.
Common Psychosomatic Symptoms
We can categorize most psychosomatic symptoms under three main complaints: insomnia, fatigue, weakness. However, a person suffering from psychological conditions may experience any of these through more specific ailments such as:
- heartburn
- depression
- irregular heartbeat
- dizziness
- pain
- cardiovascular problems
- gastrointestinal discomfort
- erectile dysfunction
- a sensation of pressure in the throat
- chest problems
- hallucinations
- and double vision (Allahverdi, 2020).
As we can see, the list is extensive and far from exhaustive. Because of the complex connections between body and mind, patients can experience psychosomatic symptoms associated with any other ailment. Doctors only label the symptom psychosomatic when they can’t medically explain the cause. Of course, this leaves us to wonder whether or not the illness is actually psychosomatic or is the doctor overlooking something.
However, when viewing illness from a wider integrative perspective, including the vast impact of stress and emotions on the physical body, even if there is no organic correlate for the illness, one should not refer to it has medically unexplained. A disrupted life is more than adequate of an explanation for physical ailments.
Causes of Psychosomatic Symptoms
Allan Schore, an American psychologist and researcher in the field of neuropsychology, wrote “it is commonly accepted that early childhood abuse specifically alters limbic system maturation, producing neurobiological alterations that act as a biological substrate for a variety of psychiatric consequences, including affective instability, inefficient stress tolerance, memory impairment, psychosomatic disorders, and dissociative disturbances” (2009, Kindle location 2,637).
Lawrence Heller PhD., a psychologist specializing in trauma, explains “emotional arousal, or when an event overpowers our sense of safety, causes a variety of brain alterations; high levels of emotions, as well as lack of emotion, lead to physical changes that contribute to autonomic dysregulation and psychosomatic disorders” (2012, Kindle location 1,807).
High emotional arousal common to trauma is the most common cause stimulating psychosomatic symptoms.
An Important Distinction
Commonly accepted in the medical and psychiatric fields of medicine, is that exposure to continual or extreme stress leads to physical ailments. In psychology, we refer to this as the diathesis, stress model. Our body responds to life events through elevating cortisol levels. Gabor Maté M.D. explains “temporary elevation of cortisol that occurs in episodes of acute stress is healthy and necessary.” This is how we biologically prepare to respond against threats. However, what is not healthy is “the chronically elevated cortisol levels in chronically stressed persons” (2008).
Stress, then, leads to illness. However, even though we typically envision stress as a psychological event of the mind, it is a physical event in the body (elevating of cortisol levels). Stress may be considered a psychosomatic risk factor but diseases an illnesses occurring because of stress are not necessarily a psychosomatic illness. Heightened and continual stress is considered a risk factor for cancer. Cancer is not a psychosomatic illness. Physicians can diagnose and treat cancer.
In contrast, last year I experience excruciating pain in my back, shoulder, and right arm. The pain persistently interfered with sleep, rest and activity. I lost muscle mass on the right side of my body. The pain was real. The physical impact of muscle loss was discoverable. However, the underlying cause remains a mystery. All tests, x-rays, and MRI’s were unable to pinpoint a cause for the pain. After three months of agony, the pain slowly subsided and I returned to normal. Perhaps, there was an underlying physical event that caused the pain that doctors were unable to discover. But then, again, maybe this was a psychosomatic illness in reaction to the heightened stress of moving (an event that occurred a month prior to the first symptoms).
A Few Closing Thoughts
We may never know whether an illness is psychosomatic or not when doctors fail to find a cause. An identifiable cause is somewhat comforting when the pain is maddening. At least we can point to something and treat it. For a large number of people, the psychosomatic illness haunts them, causing reoccurring pain, that physicians consider an illness of the mind. Luckily, some treatments addressing the mind, such as mindfulness, have healed unseen maladies, allowing the inflicted to return to normal enjoyable lives.
References:
Allahverdi, Ertugrul, (2020). Psychosomatic Pain. Effects of Stress on Human Health.
Heller, Lawrence; Lapierre, Aline, (2012). Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. North Atlantic Books; 1st edition.
Maté, Gabor (2008). When the Body Says No. Wiley; 1st edition
Schore, Allan N. (2009). Right-Brain Affect Regulation: An Essential Mechanism of Development, Trauma, Dissociation, and Psychotherapy. In The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice. Editors Diana Fosha PhD, Daniel J. Siegel M.D., and Marion F. Solomon Ph.D.. W. W. Norton & Company; 1st edition.
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