Dr Thanh-Tam Pham - 31/8/2020
Psychosomatic means mind (psyche) and body (soma).
It is an illness that connects the mind and the body and it occurs when the physiological functioning of the body is affected by the psychological tension resulting in the development of a disease or the worsening of a pre-existing disease in a person.
An improper stimulation of the autonomic nervous system which regulates the function of the internal organs is responsible for the evolution of the disorder and leads to impairment of the functional organs to a point of distress. In psychological stress, there is a hyperactivity of the nerve impulses sent from the brain to the other parts of the body causing an increase secretion of adrenaline into the blood leading to a state of anxiousness with increased heart rate, respiratory rate and muscle tension.
This condition can be triggered by various life factors in people who experience stressful events like trauma, physical, mental or sexual abuse, frequent illnesses, parental absence, relationship difficulties, deaths of loved ones leading to fear, depression, anger, guilt, insecurity…
With fear, anger and stress, the body’s fight and flight response is switched on and once this happens it can be extremely difficult to ease the resulting anxiety and tension.
When a person is angry, the blood pressure, pulse rate and respiratory rate are increased. If the person has a persistent inhibited aggression like chronic rage, the emotional state remains unchanged though unexpressed in the overt behaviour and the physiological symptoms associated with the angry state persists. With time, the person becomes aware of the physiological dysfunction and develops concerns over the resulting physical signs and symptoms but he/she denies or is unaware of the emotions that have evoked the initial symptoms. As a general practitioner, I came across many cases of elderly Vietnamese women who experience a lifelong mental, physical abuse or neglect from their husband but because of the social expectation or because of the consideration for the children’s mental health, they try to endure their loveless life. They often present with chronic
headache, tightness in chest, gastrointestinal symptoms, poor sleep and forgetfulness.
Some medical conditions are known to arise from mental stress and tension.
- High blood pressure: some psychological triggering factors like negative emotional stress, life events, economic hardship, social factors have an indirect relation with the levels of blood pressure. It is well known that many people have “ White Coat Hypertension” but people often deny of being anxious when seeing a doctor. I often asked patients to focus on the abdominal movements rising and falling with the breath without focussing on the blood pressure monitor and within a few minutes the blood pressure reduced significantly and in some instances became normal.
- Heart disease with associated arteriosclerosis: development of coronary heart disease is correlated with several risk factors such as depression, anxiety and stress. Stress can cause vasospasm of the arteries as well, causing ischaemia to the heart muscles in angina and heart attack.
- Respiratory problems: emotional stress is a major triggering factor associated with the induction of bronchial constriction in asthma.
- Gastrointestinal problems: peptic ulcer formation is related to stressful life events in the form of stress ulcers. Other digestive symptoms are very common such as nausea, vomiting, abdominal pain, constipation, diarrhea. In Irritable bowel syndrome, symptoms worsen with stress. Globus pharyngeus or globus hystericus is a feeling of a lump in the throat that is exacerbated by anxiety as patient tries to swallow saliva frequently.
- Sexual dysfunction such as pain on sexual intercourse, frigidity, erectile dysfunction, premature ejaculation, reduce libido has strong psychological causes. A young man came in with erectile dysfunction for a blood test as advised by another interstate doctor he consulted by teleheath. After more discussion, it was found he had the problem mainly when he had sexual intercourse in the period of time when his wife was most fertile as he was stressed by his father who kept demanding him to have a child soon when he was not ready to have a child. His parents live with him so he was apprehensive to go home after work. When he expressed his
wish to move out with his wife, his parents threatened to go back to Vietnam to live.
- Gynaecological symptoms such as mood changes in premenstrual or in premenopausal period and chronic pelvic pain are well established to have a strong psychological component.
- Chronic pain has an important psychological input. Anxiety about any serious causes for the pain makes the person to focus and feel the pain more and can lead to more disability as the person is afraid of any activities that may trigger the pain resulting in more muscle weakness. One of my patients came in with chronic severe bilateral jaw pain after seeing many different doctors without finding a cause. After more elaboration, it was found that the patient had severe stress after her mother’s diagnosis of terminal breast cancer and anger toward her father who had an affair.
Chronic headache from neck muscle tension is also very common.
- There can be physical effects from a mental illness. With depression, you may not eat or take care of yourself very well which can cause physical problems. People can resort to drink alcohol excessively or take drugs to forget or numb the mental pain leading to more addictive problems.
- Stress can reduce immunity as it can be seen in the recurrence of cold sores when the person is sick or stressed. Herpes simplex viruses stay dormant in the body and will be symptomatic when being stressed with life factors.
There is some evidence that emotional stress may precipitate illnesses not usually considered to be psychosomatic such as cancer, diabetes in individuals predisposed to them.
- A person may get stressed about the appearance of the body such as an obsession about being overweight and then in some severe cases may develop anorexia nervosa or bulimia.
To an extent, most diseases are psychosomatic- involving both mind and body.
People with this disorder often have an increased awareness of their own bodily functions and are likely to misattribute symptoms as the presence of a medical illness. It is also common that people often complain of vague feeling of numbness on the skin of body parts that are not consistent with a dermatomal distribution of sensory neurological deficit. People often are afraid of having a stroke when they have aching pain on one arm and one leg of the same side especially when they know someone who has hemiplegia from a stroke.
People have excessive thoughts, feelings or behaviours related to the symptom or health concern with persistent thoughts about the seriousness of symptoms.
One of my patients came in with complaints of chronic abdominal discomfort and she told me she had endoscopy, colonoscopy and CT scan ordered by other doctors. After a long discussion, she volunteered that there was a person she knew who in the past, told her many things for the future that became real and one day he told her that she might have a serious medical condition that no one will be able to detect it until late. Since then she listened to every changes or symptoms in her body. This preoccupation causes clinically significant distress and impairment in her social and occupational functioning.
There is a mental aspect to every disease.
How a person reacts and copes with a disease vary greatly from person to person. For example, the rash of psoriasis or eczema may not bother some people much but in someone else, it may make them feel depressed and more ill. By focussing on the rash and itchiness, the person cannot prevent himself from scratching and it will make the problem getting worse.
There are many causative factors responsible for the development of cancer in people. Studies have suggested that psychological stress can affect a tumour’s ability to grow and spread thereby worsening the state of cancer. Many years ago, I knew a case of an elderly patient who after being told of a lung cancer, he was depressed and lost the ability to walk and take care of himself after just a few weeks and then he died very soon after. In many Asian cultures, children often try to hide a diagnosis of malignancy from their parents as they were afraid that their health deteriorates quickly after hearing a bad prognosis. I do not believe that it is wise of doing so as when a person realises that he has a terminal illness, he can make plan to achieve what he wants to achieve in this life and by accepting death he can prepare for a peaceful state of mind when death
There is a distinction between psychosomatic disorder and hypochondriasis. Hypochondriasis is a condition in which the person believes a minor physical symptom to be a grave disease such as concluding a temporary flatulence problem into colon cancer.
Medicine has historically separated disease into either the mind or the body. Psychosomatic illness is challenging because patients present physically but have at least in part a psychological origin.
It is important to treat a person as a whole and take into account the mental and social factors which may contribute to the disease. Care should be taken to balance the potential benefits of medical testing with the potential risks. The risks of continued testing include iatrogenic damage such as irradiation and adverse reaction to sedation, incurring unnecessary costs, reinforcing the patient‘s beliefs that the symptoms are due to a serious underlying medical issue and focussing time and effort away from interventions that could truly benefit the patient.
Explanation, counselling and Cognitive Behaviour therapy (CBT) can help patients to learn new ways to cope with and solve their problems as they gain a deeper understanding of their condition.