In my immigrant home growing up, there wasn’t a lot of room for challenging emotions. If I was feeling overwhelmed, scared, sad, or (gasp!) angry, I was encouraged to disregard how I was feeling and to just keep going. My parents had many concerns, including financial matters and familial issues. My emotional state was not necessarily where my parents would focus their energy, and emotional support wasn’t a part of the landscape.
When I was sick, though, I was allowed to stay home. Sometimes, my mother would check my forehead to see if I had a temperature, a gesture I found comforting and tender from a mother who wasn’t often maternal. So frequently, during periods of stress and overwhelm, I would come down with a sore throat. While it’s likely that the stress challenged my immune system, I believe there were also other contributing factors to this pattern.
There was also a time when I was 11 or 12 years old when I just stopped being able to walk. The details are so hazy, but I remember being rushed to the emergency room and being carried in, and the doctors doing some tests. I don’t know how long this lasted, maybe a day, a few days, or a week, and then somehow I recovered. I couldn’t tell you exactly what happened, and I know there is no way I would have consciously or purposefully lost my ability to walk. What I can tell you is that, at the time, my family was under intense stress. My father was ill, my family was in the midst of a feud, the family business was falling apart, and everything was a mess. My inability to walk was likely psychosomatic. It was real, but I’m guessing it’s not something the doctors could diagnose right away (if at all).
What Does It Mean When Something is Psychosomatic?
It’s easy to understand that blushing results from feeling embarrassed or self-conscious. We get it: there is a connection between our emotional and physical experiences. Indeed, our emotional states have long been recognized as closely linked to physical or somatic responses in the body. The term “psychosomatic” comes from the Greek words ‘psycho,’ meaning mind, and ‘somatic,’ meaning body. Despite this understanding, many still struggle to accept that the body and mind function as a single system. Psychosomatic disorders or experiences are frequently dismissed as not real or considered less serious than more widely understood symptoms. However, pain or discomfort experienced due to these conditions is genuine, regardless of origin. According to research, the term psychosomatic is mainly used to describe a problem that is psychological or in which the mind affects the body.
Suzanne O’Sullivan, a neurologist who has spent her life studying psychosomatic illness, further explains that a psychosomatic illness “is a disorder in which people get real physical symptoms that cannot be explained by physical examination or medical tests. No disease can be found to explain them. And there is usually believed to be a psychological or behavioral cause.”
What are Psychosomatic Disorders?:
The mind-body connection refers to the idea that the mind can influence an individual’s physical health and that our physical health can also influence our mental health. There are many theories about how or why this may occur. Researchers suggest it happens through a complex interplay of hormones, nervous system interactions, immune responses, and behavioral factors. High-stress situations may trigger the release of hormones that provide our nervous systems with signals on how to react (fight or flight). This interaction can cause physical symptoms like elevated heart rate, sweating, and muscle tension. Similarly, researchers have shown that psychological stress suppresses a healthy immune response, leading to the development or worsening of illness and disease as one becomes more susceptible to infection and decreased healing time.
The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM 5) includes a section titled: Somatic Symptom and Related Disorders. All of the disorders under this heading share the prominence of somatic symptoms associated with significant distress and impairment. While all diagnoses may include medically unexplained somatic symptoms, what defines them is how the symptoms present and how the individual interprets the somatic symptoms. Other mental disorders result in somatic symptoms, too, including major depressive disorder and panic disorder.
The DSM 5 relays that the factors that may contribute to somatic symptoms and related disorders include genetic and biological sensitivities, early traumatic experiences, learning, and cultural and “social norms that devalue and stigmatize psychological suffering as compared with physical suffering.”
With Somatic Symptom Disorder, one or more somatic symptoms are distressing or result in significant disruption of daily life. The individual experiencing the symptoms may experience disproportionate and persistent thoughts about the seriousness of their symptoms, experience a persistently high level of anxiety about their health or symptoms, and devote “excessive” time and energy to their symptoms or health concerns.
Illness Anxiety Disorder, formerly known as Hypochondriasis, is another diagnosis in the DSM 5. To be diagnosed with Illness Anxiety Disorder, the individual must present as preoccupied with having or acquiring a serious illness, somatic symptoms may not be present or are mild in intensity, there is a high level of health anxiety, the person struggling will perform health-related behaviors like checking their body for signs of illness or will avoid going to the doctor or being seen by medical professionals, and the preoccupation will have been present for at least six months.
Conversion Disorder is another diagnosis. With Conversion Disorder, the individual experiences one or more symptoms of altered voluntary motor or sensory function, and “clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.” Another medical or mental disorder does not explain the symptom or experience, and it causes significant distress or impairments in social, occupational, or other important areas of functioning.
Any of the above diagnoses can be difficult to manage and navigate. They may exacerbate mental health challenges and contribute to additional feelings of anxiety, depression, hopelessness, and confusion. To experience physical distress and not be able to locate the source, to see countless doctors without receiving support, or to feel too afraid to see a doctor out of fear of what they may find can all be very troubling. The stigma associated with these diagnoses can also contribute to greater frustration and difficulty accessing support.
Under the same section, the DSM 5 lists Factitious Disorder, which can either be imposed on the self or another. Factitious Disorder includes falsification of physical or psychological signs or symptoms, with the individual presenting themselves or another as ill, impaired, or injured. Per the DSM, “deceptive behavior is evident in the absence of obvious external rewards,” and another mental disorder does not better explain it.
Factitious disorder is listed as a somatic disorder because it involves the manifestation of symptoms related to psychological factors. Nonetheless, pairing them together may further illustrate the challenge of diagnosing and conceptualizing somatic disorders. In Factitious Disorder, one is intentionally producing or feigning physical or psychological symptoms to assume the sick role. With the other somatic disorders, the symptoms are naturally occuring. In fact, research supports that there are changes in brain scans when one is experiencing psychosomatic symptoms, which supports that the symptoms are not feigned but are indeed real and impactful.
What Causes Psychosomatic Symptoms?
Unfortunately, psychosomatic symptoms are psychosomatic because we don’t know the exact cause. While there are differing theories about what factors influence the development of psychosomatic disorders, many researchers theorize that it is a combination of biological/genetic predispositions, environmental and social influences, and of course, psychological factors. From a biological perspective, researchers have found that the predisposition for bodily distress and chronic pain, in general, have some genetic linkages and that the same could be said for one’s likelihood of developing a psychosomatic disorder. Similarly, research is being conducted into what epigenetic factors, if any, are at play; given their role in the inheritance of intergenerational trauma, this seems to be an important consideration.
Opinions vary widely on the influence of environmental and lifestyle factors on the development of psychosomatic disorders. However, the consensus is that one’s environment significantly impacts their predisposition to these disorders. Factors such as a history of trauma, periods of increased stress at work, and lack of social support have all been linked to the development of psychosomatic disorders. For instance, conversion disorder often manifests suddenly following an event that causes extreme stress and anxiety. Additionally, cultural attitudes toward mental health and illness can shape how individuals perceive and report their symptoms. In some cultures, physical distress is more socially acceptable than mental distress, leading individuals to develop psychosomatic disorders as an expression of their emotional and mental suffering.
And though it may seem pretty obvious, psychosomatic disorders often regularly occur in conjunction with other mental health disorders. Anxiety and depression are common, as previously mentioned, but mood disorders, personality disorders, and substance use disorders are also all risk factors for psychosomatic disorders.
It’s also worth naming that some disorders that were conceived of as psychosomatic later became better understood and removed from this category. For example, fibromyalgia, which is a chronic pain disorder, was once met with skepticism and dismissed. Over time, as it was researched and better understood, doctors came to understand fibromyalgia as a multifactorial condition influenced by genetic, neurobiological, environmental, and psychological factors. As doctors and scientists learn more about the body and our whole system, including the relationship between the mind and body, things will likely become clearer and clearer.
Why Is It So Hard to Get Support for Psychosomatic Symptoms?
Psychosomatic disorders involve both physical and psychological components, making them difficult to understand and diagnose. The lack of clear medical evidence for the physical symptoms can lead to misunderstandings and skepticism. Additionally, many healthcare professionals receive limited training on psychosomatic disorders, leading to a lack of awareness and understanding. This can result in misdiagnosis or dismissive attitudes towards patients.
There’s also the social context to consider. Historically, conditions without clear medical explanations were often dismissed as “hysteria” or “imagined” illnesses. These outdated views have contributed to lingering negative perceptions. And the traditional medical model tends to prioritize physical over psychological explanations, leading to a bias against conditions where psychological factors play a significant role.
Ultimately, this makes coping with and caring for somatic symptoms even more difficult. Clients with psychosomatic disorders often feel invalidated and misunderstood. When their symptoms are dismissed as “all in their head,” it can lead to feelings of frustration, shame, and isolation. Clients might also internalize societal attitudes, blaming themselves for their symptoms or doubting their experiences. The stress and self-blame can exacerbate their condition and make it even harder to seek help.
So where can you start, and how can you cope with psychosomatic symptoms? With any physical symptoms, clients are always encouraged to seek medical attention first to rule out any identifiable causes. This will help ensure that any potential physical health issues are addressed appropriately. For those who have already met with medical doctors and have yet to have a clear answer, treatment needs and preferences will likely vary significantly from person to person. Most individuals will likely benefit from some combination of psychotherapy, pharmaceutical interventions, treatment from a medical doctor, and stress management skills and coping strategies. If you’re just getting started with this process, here is what might help.
Where Can I Start When Coping With Somatic Symptoms?
Validate Your Feelings:
Acknowledge that your symptoms are real, and that seeking help is okay. What you’re experiencing is not easy; if you are suffering, you are suffering. Validating your experience is the first step towards accessing the support you deserve.
Offer Yourself Compassion:
Trying to understand what is happening within your body can be exhausting and overwhelming, and trying to figure that out while you’re uncomfortable, afraid, or in pain is even more difficult. It’s essential to be kind to yourself during this process. Speak to yourself with the same kindness and understanding that you would offer to a friend, and offer your body opportunities to rest and provide it with care.
Keep Learning:
Educating oneself about the nature of somatic symptoms and their psychological connections can reduce fear and uncertainty. Keeping a symptom diary to track when you’re experiencing symptoms, and knowing what might trigger them can help identify patterns and develop strategies to manage them.
Experiment With Ways to Manage Stress:
Being told to stop feeling stressed when stressed can understandably have the opposite effect! And some activities that work for some to help them manage stress may cause others to feel more stress. Get curious about what might work for you, and try different activities if you can. Physical activities, like yoga, walking, and swimming, can help reduce stress, improve mood, and alleviate some physical symptoms. If those don’t work for you, deep breathing exercises, progressive muscle relaxation, and meditation may be worth exploring. Hobbies have also been found to help us feel less stressed and can provide a mental break from focusing on symptoms.
Seek Emotional Support:
Talk to someone you trust about what you’re experiencing. Sometimes, just sharing your thoughts and feelings can provide relief and help you feel less isolated. If friends or family are not available or can’t offer you the support you need, consider joining a support group where you can connect with others facing similar challenges. Joining support groups for individuals with similar conditions can provide a sense of community and shared understanding. Psychotherapy has also been found to help with psychosomatic symptoms and somatic disorders, and may be highly beneficial.
Growing up in an immigrant home, I quickly learned to navigate a landscape where emotions were not always welcome. Despite the minimal emotional support, physical illness provided a rare avenue for tenderness and care. This duality of experience—where physical symptoms were acknowledged but emotional distress was often dismissed—mirrors the broader societal struggle to recognize the legitimacy of psychosomatic symptoms.
Understanding the mind-body connection is crucial. Psychosomatic symptoms are real and can be just as debilitating as symptoms with a clear physical cause. The stigma and misunderstandings surrounding these symptoms and disorders can make it challenging to seek and receive appropriate care. But there is hope. By validating your experiences, offering yourself compassion, and seeking appropriate support, you can navigate this complex landscape. Remember, you deserve to feel heard, understood, and supported in your physical and emotional health.
Ultimately, recognizing the legitimacy of somatic symptoms is a step towards destigmatizing these conditions and ensuring that everyone receives the compassionate care they need. Your journey toward understanding and managing your symptoms is valid; you don’t have to be alone in this process. If you think you’d benefit from additional support, please reach out. We would be honored to be a part of your team.