Somatization: Is What I’m Feeling All in My Head?

When I educate medical health professionals about the complex links between emotional functioning and physical health, many express a fear that their patients will respond to a referral to therapy by saying, “So, are you saying this is all in my head?” I will try to provide a useful, realistic answer to this potentially thorny question.

Body, Mind, or Bodymind?

Modern neuroscience has helped us begin to see that the separation of body and mind is more a matter of grammatical convenience than scientific truth. Our nervous system, the network of cells that helps our brains connect with the rest of our organs, links our emotional processing center to every structure of our physical being. This has led some to use the term “bodymind” in recognition of the idea we gain nothing by continuing to arbitrarily separate mental life and physical life when they are so clearly interwoven (e.g., Keleman, 1989). When we think about ourselves as bodyminds, it begins to make sense that many physical symptoms are exacerbated or caused by emotional processes.

How Emotions Become Physical Symptoms

Much developmental theory and research has helped demonstrate that experiences in our development, especially with our caregivers, shape our relationship to our emotions (e.g., Felitti, et al., 1998). We tend to treat our emotions similarly to how they were treated by others (Frederickson, 2013). As a result, those of us who had parents who responded to our emotions with anxiety, misattunement, or even punishment may develop anxiety about our own emotions. Many people experience anxiety when emotions are triggered by relationships and events in their day-to-day lives.

Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

Anxiety can manifest physically in the body in many ways. It can cause our skeletal muscles to tense, leading to pain and cramps. It can cause tension in the smooth muscles of the bowels, vascular system, urogenital system, and bronchi, leading to a variety of symptoms such as irritable bowel, hypertension, sudden urge to urinate or defecate, and difficulty breathing. Anxiety at very high levels can even cause changes in the flow of blood and oxygen to the brain, leading to difficulties thinking and perceiving the world, such as dizziness or blurry vision (Frederickson, 2013).

I point all this out to illustrate that anxiety triggered by the emotionally evocative events of our daily lives can produce a huge variety of physical symptoms. These symptoms can easily be, and often are, diagnosed and treated as if they are purely somatic, without considering the possibility emotional factors might be a major contributor. This can result in failed treatments and frustrated patients. See my other articles for more detailed information on the links between emotions and physical symptoms.

So, Is It All in Your Head?

The fact that emotional factors are contributing to your symptoms does not mean your symptoms are fake, as the notion of “all in your head” seems to suggest. Emotional factors create very real physical symptoms that are often mistaken for symptoms that have a purely medical origin. A recent study even showed that the brain of a person in emotional pain, when observed under fMRI, has a similar appearance to the brain of a person in physical pain (Kross, et al., 2011).

When we treat emotion-driven symptoms as if they are purely physical, and deny the component that is “in the head,” health care costs go up, symptoms persist or worsen, and frustration grows. Alternatively, evidence is beginning to show we can save time and health care costs by treating medically unexplained physical symptoms with psychotherapy (Abbass, et al., 2010).

Despite this evidence, it seems many medical practitioners fear their patients will be hurt by a referral to psychotherapy. There is some truth to this: many health care consumers are upset by the possibility their physical symptoms may have an emotional engine, and sometimes they exhaust all other diagnostic and treatment options before pursuing counseling. I hope the information presented here and in my other posts on somatization will help patients and practitioners to reap the benefits of a clearer understanding of the bodymind and the links between emotions and physical symptoms. Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

References:

1. Abbass, A., Campbell, S., Hann, G., Lenzer, I., Tarzwell, R., & Maxwell, D. (2010). Cost savings of treatment of medically unexplained symptoms using intensive short-term dynamic psychotherapy by a hospital emergency department. Journal of the Academy of Medical Psychology, 1, 34-43.
2. Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., & Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
3. Frederickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves.
4. Keleman, S. (1989). Your body speaks its mind. Berkeley, CA: Center Press.
5. Kross, E., Berman, M.G., Mischel, W., Smith, E.E., & Wager, T.D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of the Sciences of the United States of America, 108, 6270-6275.

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