There is strong evidence that people with psychological trauma often experience unexplained physical discomfort or pain. Unfortunately, this can lead the individual to pursue unnecessary medical care: repeated tests that don’t yield results, medications prescribed without providing relief, and even needless hospitalizations and surgical treatments which may damage quality of life and drain one’s resources. The inability to find relief from physical ailments can cause further distress for the individual and create feelings of helplessness, depression, and anxiety.
It is important to understand that physical symptoms stemming from trauma can be treated. If you are experiencing chronic pain or other physical symptoms that your doctors haven’t been able to explain, you may want to see a therapist to talk about what might be bothering you emotionally. Some people are not used to talking about their feelings and may wonder how psychological treatment can possibly reduce physical symptoms. However, there are many recorded cases that demonstrate how therapy can relieve distressing and unexplained physical symptoms.
Two Case Studies
Around the early 1900s, psychologists began to link certain cases of paralysis, epilepsy, convulsions, and pain to underlying emotional distress and psychological conflict. Freud called this phenomenon “hysteria”.
The case of Anna O. is an early example of psychological distress manifesting as physical symptoms. Anna was a 21-year-old woman who developed a range of physical symptoms after caring for her dying father. Beginning with a severe cough, her illness progressed to paralysis of the extremities on the right side of her body. She developed disturbances in her vision and hearing which progressed to the point of temporary blindness and deafness. Anna also developed hallucinations, phobias, and high states of anxiety.
If we have suffered trauma, our stress and disturbed emotions will be expressed in some way. Trauma can find expression by affecting the body in the form of unexplained physical illness or pain.Treatment for Anna began with a new approach for the that time period. Rather than focus on helping Anna correct her behavior, her doctor aimed to help her “unfold” suppressed mental stress. She was encouraged to talk about what she was going through and express herself. Anna eventually made a full recovery and described her treatment as her “talking cure.”
A more recent case is discussed in Gordon Turnbull’s book Trauma: From Lockerbie to 7/7: How Trauma Affects Our Minds and How We Fight Back. In the book, a 35-year-old woman suddenly could not walk anymore or feel her legs. Without a physical injury, the nurses thought she was faking.
Upon extensive interviewing, her clinician learned the woman was sexually assaulted by someone she knew. The “unbearable mental conflict” was pushed out of her conscious awareness in order to protect herself from emotional distress. However, talking about her experience repeatedly allowed her to feel relief. Two days later, she walked out of the hospital on her own two feet.
Somatic Symptom Disorder and Conversion Disorder
Today, we no longer diagnose individuals with hysteria. Physical symptoms without a physical cause are often diagnosed as somatic symptom disorder (SSD) or conversion disorder. An individual with SSD may have symptoms which interfere with their body’s ability to function, yet they show no signs of illness or injury. Conversion disorder occurs when emotional distress is converted into neurological symptoms such as tremors.
If an individual has physical symptoms they can’t explain, they should always see a medical professional to rule out relevant diagnoses. If the medical team is unable to discern a physical cause for the symptoms, they may refer the individual to a therapist. A trained mental health professional can screen the person for SSD or conversion disorder.
Criteria for somatic symptom disorder include:
- One or more physical symptoms that are distressing and interfere with functioning.
- A person is consistently symptomatic for at least six months. (The particular symptoms may come and go, but there is at least one symptom present at any point in time.)
- Excessive or time-consuming behaviors related to the physical symptoms.
- Ongoing thoughts or worries that are disproportionate to the physical symptoms.
- High levels of anxiety about health.
Criteria for conversion disorder include:
- Neurological symptoms such as weakness, limb paralysis, or issues with balance.
- Episodes of unresponsiveness.
- Difficulty swallowing.
- Difficulty walking.
- Other sensory interruptions or symptoms, such as difficulty hearing, blurred or double vision, episodes of blindness, slurred speech, inability to speak, and numbness.
Cognitive behavioral therapy (or a combination of cognitive behavioral therapy and antidepressants) has been shown to reduce symptoms of SSD and conversion disorder. Therapy can also address underlying trauma and improve emotional well-being.
Why Therapy Helps
Part of Freud’s important discoveries was that distressing and disturbing memories do not just go away. If we have suffered trauma, our stress and disturbed emotions will be expressed in some way. Trauma can find expression by affecting the body in the form of unexplained physical illness or pain.
Therapy allows trauma to be processed. It provides a safe environment to express past hurts and fears so healing can begin. Therapy can also teach trauma victims healthy ways of coping. Taken together, this not only allows the individual to express current distress but also to implement coping strategies that ultimately decrease emotional upset.
In other words, therapy does not treat physical symptoms on the surface level. Instead, it typically addresses symptoms in the context of unresolved complex trauma.
You can find a licensed therapist here.
References:
- Anna O: Sigmund Freud’s case history. Psychologist World. Retrieved from https://www.psychologistworld.com/freud/anna-o-case-study-freud
- International Society for the Study of Trauma and Dissociation. (2011, March 3). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187. Retrieved from https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
- Kallivayalil, R. A., & Punnoose, V. P. (2010). Understanding and managing somatoform disorders: Making sense of non-sense. Indian journal of psychiatry, 52(Suppl1), 240-245. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21836685
- Nicholson, C. (2017). Why Freud was right about hysteria. The Conversation. Retrieved from https://theconversation.com/why-freud-was-right-about-hysteria-86497
- Patient story: Somatic symptom disorder. (n.d.). Retrieved from https://www.psychiatry.org/patients-families/somatic-symptom-disorder/patient-story
- Rosic, T., Kalra, S., & Samaan, Z. (2016, January 12). Somatic symptom disorder, a new DSM-5 diagnosis of an old clinical challenge. BMJ Case Reports. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26759438
- Turnbull, G. (2011). Trauma: From Lockerbie to 7/7: How trauma affects our minds and how we fight back. New York, NY: Random House.
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