What are psychosomatic disorders and how common are they?

You may have seen lists of causes of various diseases, where it is stated that myopia occurs due to fear of the future, and sore throat – from unspoken rude words. Evidence-based medicine is skeptical of such statements, but severe stress and nervous tension can really do harm. Let’s figure out what psychosomatic disorders are, why they develop and how they can manifest themselves.

What are psychosomatic disorders and how common are they?   

The term “psychosomatics” comes from the Greek words psyche (“mind”) and soma (“body”). Psychosomatic, or somatoform, disorders are conditions that cause unpleasant and even painful physical symptoms, but do not have underlying pathology of organs and systems.

An important nuance of these symptoms is that they bother people a lot, to the point of obsession and fixation of thoughts only on them. A person does not invent illnesses for himself, it does not seem to him that his heart beats faster than usual or that his stomach hurts – he actually feels physical discomfort.

Even when examinations by specialized specialists, tests and studies do not confirm the disease, such people may still visit one doctor after another, because the symptoms are there, and the treatment does not help. It can be difficult for them to accept the fact that in fact they need to see a psychologist or psychotherapist.

Such stories are quite common: medically unexplained symptoms or syndromes affect the health of 20 to 30% of patients who seek medical attention with a suspected illness, but are not diagnosed with it.

Is it true that diseases develop due to suppressed emotions and fears?

In 1934, physician and psychoanalyst Franz Alexander attempted to explain the nature of psychosomatic disorders. He identified the so-called “Chicago Seven” – a group of diseases that could have psychosomatic roots. It included 7 diseases: duodenal ulcer, ulcerative colitis, rheumatoid arthritis, bronchial asthma, neurodermatitis, hypertension and thyrotoxicosis. 

The essence of Alexander’s concept was that in trigger situations some people do not have the strength and skill to release emotional tension externally. As a result, all this flows into pathology of internal organs and systems.

Thus, according to Alexander, patients with duodenal ulcers often had an internal conflict between the need for psychological dependence and the fear of openly demonstrating this dependence. Explanations were also found for the other diseases of the “Chicago Seven” : for example, bronchial asthma is supposedly caused by separation anxiety, essential hypertension by suppressed hostility, and thyrotoxicosis by the fear of self-destruction.

But evidence-based medicine has a different opinion about the causes of all these diseases. Take, for example, gastric ulcer and duodenal ulcer. Back in 2005, scientists Robin Warren and Barry Marshall were awarded the Nobel Prize in Physiology or Medicine for discovering the medical significance of the bacterium Helycobacter pylori, which contributes to the development of acute gastritis and ulcers.       

Bronchial asthma, for example, also stands out from the Chicago Seven concept. Scientists do not yet know 100% what causes the disease. Only risk factors and triggers are known. The former increase the likelihood of its occurrence, and the latter can provoke asthma attacks. Risk factors include a family history of the disease, when asthma was in close relatives, an allergic disease, such as atopic dermatitis, excess weight with a BMI of 30.0, and smoking. Triggers can be colds, exposure to allergens – pollen or animal dander, strong emotions and stress. 

Although there is an emotional factor among these triggers, it is not separation anxiety, as in Alexander, but mental overstrain. In addition, triggers are only effective in combination with several of the above risk factors. Therefore, it is incorrect to say that bronchial asthma has a psychosomatic nature .

The modern theory of organic disorders, associated with psychosomatics, suggests that not only emotions play a role in the development of diseases, but also an unhealthy lifestyle with a high level of stress, as well as a genetic predisposition to certain diseases.

Why do psychosomatic disorders occur?

We usually talk about the mind and body as if they were two separate phenomena. But they are not. The brain sends signals to the body through nerve impulses and hormones, and we are confronted with the manifestation of feelings in the body every day. When we are embarrassed, we immediately blush, anxiety (including pleasant ones) is felt as “butterflies in the stomach”, and from strong emotions it is as if a lump gets stuck in the throat. Therefore, psychosomatic symptoms often reflect an emotional or psychological state to the extent that emotions activate the involuntary nervous system and endocrine glands: the thyroid, pancreas and adrenal glands.

This clear connection is also observed during stress. When a person is faced with a threat, such as an attack by a dog, a small part of the brain called the hypothalamus triggers the fight-or-flight stress response system. 

Using nerve signals and hormones, the brain stimulates the adrenal glands to produce adrenaline and cortisol. As a result, the heart begins to beat faster, blood pressure rises, and cortisol increases sugar levels and suppresses the digestive, reproductive, and growth systems. Once the danger disappears, the body stops responding to stress: hormones return to normal levels, the heart beats more slowly, and blood pressure decreases. 

This disrupts almost all processes in the body, and as a result, health problems may arise. Here are just a few possible consequences of living in constant stress:

• Anxiety;
• Depression;
• Digestive problems;
• Headache;
• Muscle tension and pain;
• Heart disease, heart attack, high blood pressure and stroke;
• Sleep problems; 
• Weight gain;
• Problems with memory and concentration.

In some cases, stress aggravates existing problems. For example, people with stomach ulcers, psoriasis, eczema, high blood pressure, and cardiovascular diseases may notice that their mental state can affect their well-being. If they get nervous, the disease will make itself known. 

How psychosomatic disorders can manifest themselves

These disorders have a number of typical symptoms. Most often, patients come to the doctor with the following complaints:

• Heart problems: pain, irregular heartbeat, tingling in the chest;

• Chest discomfort and lung problems: feeling of shortness of breath, pain, heaviness and pressure when breathing; 

• Problems with the stomach and intestines: abdominal pain, heaviness, nausea, lump in the throat; 

• Muscle and joint pain; 

• Feeling of weakness, lethargy, numbness of legs and arms; 

• Profuse sweating, hot flashes and chills;

• Dizziness, chronic headaches.

Characteristically, with all the variety of complaints, patients may not mention their depressed mood and feelings. Only upon more detailed questioning about the nature of the complaints and the conditions under which they arise will they note that they are very tired, sleep poorly, and are anxious. At the same time, people do not associate their emotional state with somatic, that is, physical symptoms. 

At the same time, unexplained malaise may be a manifestation of a mental disorder. Thus, with depression, the head and back may hurt for no apparent reason, constipation occurs , appetite decreases, and the person feels unexplained weakness. With generalized anxiety disorder, stomach pain  is common , the heart beats unusually fast and hard, nausea and shortness of breath may appear.

How are psychosomatic disorders diagnosed?

Each person has a different attitude towards health problems. Some will ignore back pain until the very end and dull it with painkillers, while others will go to the doctor at the slightest tingling in the chest.

If a patient is very worried about his condition, this does not mean that the doctor will immediately determine that he has a psychosomatic disorder. First, it is necessary to exclude pathology of organs and systems. For each disease, there is a necessary minimum of examinations, some of which must be done as part of an annual check-up. For example, these are general blood and urine tests, electrocardiography and fluorography.

It is a completely different matter if, during the survey, the patient assures the doctor that he has a serious and incurable disease, and complains that no one has yet been able to make a diagnosis and prescribe competent treatment. This is where one can suspect a somatoform disorder. Additional arguments in its favor will be: 

• A history of repeated visits to other doctors and medical institutions with the same complaints and no diagnosis. 

• Examination of the patient without detection of pain during palpation, abnormal organ sizes or extraneous noises in the lungs and heart.

• Several consecutive negative test results and studies related to the disease that the symptoms may indicate. 

To make a final diagnosis of a psychosomatic disorder, the patient’s entire medical history must fit the following criteria: 

• There are one or more symptoms that are bothersome or interfere with daily life. 

• The symptom or symptoms have been present for at least six months. 

• The person is constantly haunted by thoughts about these symptoms.

With such complaints, you can contact your local therapist. And if he determines the nature of the symptoms as psychosomatic, he will refer you to a psychologist or psychotherapist.

How to cope with psychosomatic disorders

It is useless to fight only the symptoms: it is important to work with the cause of their occurrence. A psychotherapist or psychologist can prescribe cognitive behavioral therapy (CBT), which helps reduce stress, cope with the physical manifestations of the disorder and worry less about them, fight depression and other psychological problems, and ultimately improve the quality of life.

A full recovery may require several dozen sessions. And during this time, the doctor may prescribe antidepressants. They help cope with symptoms associated with depression and pain, which often occur with somatic disorders, and reduce anxiety about them.

The following measures can help stabilize the condition and enhance the effect of cognitive behavioral therapy :

• Regular physical activity. If you need to cope with stress, jogging , cycling, and working out in the gym will do – the main thing is to move.
• Sleep hygiene. It is important to sleep at least 7 hours a day, trying to go to bed at the same time.
• Practice stress reduction techniques . These may include deep breathing techniques, meditation, yoga.
• Limit alcohol consumption. Alcohol can dull the feeling of anxiety due to physical symptoms, reduce tension, and give a false sense of energy. This occurs because alcohol depresses the central nervous system. But when you come out of alcohol intoxication, anxiety can become even stronger, and nausea, vomiting, and hallucinations can be added to it.