Complex physical symptoms and syndromes like irritable bowel syndrome, migraines, and fibromyalgia are all too common among folks struggling with emotional difficulties, and mounting evidence supports a causal connection between emotional struggles and physical suffering. The emotional forces that can drive or worsen our physical symptoms are often operating automatically, instantaneously, and out of awareness, which makes them difficult to diagnose and treat in a purely medical setting. Our medical establishment has also been slow to integrate current understandings of the mind and body into the training of physicians and allied health professionals. This can lead to frustrations for help-seekers and the medical professionals trying to help them.
Many symptoms and syndromes are labeled “medically unexplained” because physical testing and treatment do not reveal the root cause of the suffering. As a result, we wind up with a diagnostic label that describes our symptoms, but does not explain why the symptoms are happening. When we don’t know the root cause of a symptom, we can treat it only in superficial ways—we treat the symptom, but not the cause. This is like using aspirin to treat a fever when the fever is caused by a bacterium that would be better treated with antibiotics; though the fever may decrease, it will come back until we address the underlying cause. We can wind up going through life trying to prevent and treat flare-ups of symptoms, not knowing there are resources out there that might help us address the deeper roots of our physical problems.
There is a growing body of evidence that talk therapies can help us to understand and treat the emotional roots that can underlie medically unexplained symptoms, especially when physical assessments and medical treatments have not produced adequate results. In this article, we will explore the most common pathways that link our emotional minds to our physical bodies, so that you can have a better understanding of the emotional drivers of medically unexplained physical symptoms as you decide whether to seek therapy as a possible treatment.
But first, an important disclaimer: Because the pathways described below often occur “unconsciously,” or out of awareness, they can still be happening even if you are not consciously aware of them or noticing them. A therapist who is competent in treating medically unexplained symptoms may be a useful ally in helping you begin to notice whether these symptom-generating emotional pathways are impacting you.
Every physical structure of the body is linked to the emotional centers of the brain by the somatic and autonomic branches of the nervous system. Many events that occur in life, even ones that don’t seem stressful at a glance, can trigger an anxiety response that manifests in the body. Anxiety can be conscious (related to our thoughts and expectations) or unconscious (related to feelings and reactions that are out of our immediate awareness), and innumerable bodily responses can be activated by the body’s natural anxiety response. There are three common “pathways” or patterns of activation that anxiety takes in the body (e.g., Abbass, 2015):
- Skeletal muscle tension: Every skeletal muscle you can tense voluntarily can be tensed involuntarily by anxiety, contributing to stiffness and pain from the tension. Fibromyalgia and other chronic pain conditions can be linked to chronic tensing, as can tension headaches and difficulty breathing (tension in the chest muscles). Tension in the large muscles can also cause scary symptoms such as tingling, numbness, or feelings of cold in the skin because blood flow goes away from the skin into the muscles when they are chronically tense. Muscle tension from anxiety can also interfere with recovery from injuries.
- The smooth muscles: The smooth muscles are the squishy muscles that line the gut, veins, arteries, capillaries, bronchi, and urogenital systems. They can all be activated in response to anxiety as part of the body’s stress response. This can contribute to gastrointestinal symptoms such as diarrhea, nausea, constipation, and acid reflux. Tension or inflammation in the veins, arteries, and capillaries of the vascular system, which can be triggered by anxiety, can contribute migraine headaches and hypertension. Asthma symptoms that lack a medical explanation, known as “reactive airways,” can be caused by anxiety-induced spasms in the lungs. Finally, sudden urges to urinate or defecate can be caused by anxiety channeled into the urogenital system.
- The brain: Severely dysregulated anxiety can lead to changes in the flow of blood, oxygen, and neurohormones to important centers in the brain, causing our thinking and our five senses to disrupt. This high level of anxiety can contribute to concerns such as difficulty thinking and focusing, dizziness, fainting, and distortions of the senses (e.g., tunnel vision, blurry vision, hallucinations). We often take these impairing concerns to neurologists, but when a medical explanation is not found, anxiety may be a cause.
For some people, rather than being able to feel emotions as they are triggered in their body, they will experience motor weakness, numbness, or heaviness in the limbs. This sudden, unintentional, and unplanned loss of tone, sensation, and motor power seems to be a way their bodies have learned to prevent feelings and the impulses attached to them from being fully felt and accepted, and may be linked to emotional trauma in close relationships (Abbass, 2015). Conversion symptoms often co-occur with depression and can be misdiagnosed as purely medical in origin.
In my experience, the emotional factors that underlie physical pain are rarely as simple as they seem. Sometimes we can make a differential diagnosis about where the pain is coming from rather quickly, but other times it will take a therapist some time to get to know you, so that the two of you can gain a deeper understanding of the origin of the symptoms.
Somatization might be easier to understand if we refer to it as “sympathy symptoms” (Abbass, 2016, personal communication). With sympathy symptoms, pain is the result of our sympathy with and love for the person or people we are angry or enraged with. Psychoanalysts call this identification with the object of rage (Frederickson, 2014). In somatization, when anger is triggered toward a loved person, usually at an unconscious level, out of awareness, any physical impulses attached to that anger are deflected back onto the body. For example, during therapy a person presenting with crushing chest pain may become aware of buried impulses to damage the chest of someone they love. In somatization, these impulses were turned back against the self, often as an unconscious self-punishment because of guilt about the impulses and out of love for the fantasied “victim” of the anger. In therapy for somatization, people are helped to simply feel and accept these impulses without acting on them or somatizing them. This may sound like some woo-woo psychoanalytic theorizing, but the link between repressed anger and physical symptoms is becoming more and more accepted in mainstream pain medicine (see the work of John Sarno, e.g., Sarno, 2007).
Naturally, we become distressed when we experience physical pains and symptoms that do not have an explanation. Some of us try to “solve” the mystery ourselves with a strategy called obsessing. When we obsess about our symptoms, we may “check” frequently to see if it’s happening, and as a result we may notice or worry about it more. We may think a lot about the symptom, sometimes catastrophically: think “what would happen if I got nauseous now?” or “what if I feel pain on vacation?” We may get on the internet and do research about our condition. Sometimes obsessing can help, and we might even come up with some answers on our own. However, obsessing can lead us to become more anxious in our bodies, causing our symptoms to flare. Obsessing can also lead us to fixate and focus our attention on our symptoms in a way that can lead us to notice them more and thus feel worse. Obsessing about our pain or injuries can add an unnecessary component of emotional suffering to the built-in pain of injuries and illnesses that have a purely physical origin. Symptoms are bad enough. Though it’s tempting, obsessing often makes them worse.
In my experience, the emotional factors that underlie physical pain are rarely as simple as they seem. Sometimes we can make a differential diagnosis about where the pain is coming from rather quickly, but other times it will take a therapist some time to get to know you, so that the two of you can gain a deeper understanding of the origin of the symptoms. This can especially be the case if the symptoms have been going on for a long time or if you have difficulty opening up about emotions in therapy.
Though sometimes the pain is purely psychological in origin and resolves quickly with therapy, there is always a possibility the symptoms are caused by physical factors that have not been diagnosed or adequately treated. In these latter situations, we can work in therapy to subtract the percentage of the symptoms that are caused by certain emotional factors. Therapy cannot promise a pain-free life, but it can realistically offer a life without the pain that is made worse by the unconscious, automatic psychological pathways described above.
If you have been experiencing physical symptoms, medical tests have been inconclusive, and somatic interventions have failed to relieve your suffering, consider scheduling a consultation with a mental health professional, especially one who has unique training in working with emotional factors in physical health conditions.
- Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.
- Frederickson, J. (2014). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves Press.
- Sarno, J.E. (2007). The divided mind: The epidemic of mind-body disorders. New York, NY: Harper.
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