After a tough day at the office, you feel a piercing headache coming on; or after a long night worrying about a family member, your stomach starts acting up.
Why does this happen? And is it all in your mind, as some of your family members may think? We asked the experts.
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Precisely what is happening here may still be unclear, though researchers are fast unravelling the complex crow’s nest of the mind-body relationship. But that the mind and body are deeply intertwined, is clear enough.
According to Dr Jacqueline Muller, a psychiatrist from Pretoria, “physical symptoms that cannot be explained by a known medical illness or substance, and where psychological factors play a role in the onset or exacerbation of the symptoms,” are called somatoform symptoms (formerly referred to as psychosomatic symptoms).
How it works
According to Muller, “the exact mechanism of somatisation and the body's response to stressful events remain unclear.” There is, however, a good deal that we do know.
“There are short- and longer term responses to stress. In acute stress, certain chemicals (like noradrenalin and serotonin) and hormones (like cortisol) play important roles in the adaptation to stress. This may cause fluctuations in blood pressure, pulse rate, respiratory rate and pain sensitivity, and influence your emotional experience of events,” says Muller.
In short, something like an argument with your spouse, and not knowing how to deal with it, may set in motion a cascade of chemical and hormonal reactions in your body that will eventually leave you lying on your back with a nightmarish migraine, or some other debilitating condition.
A bit of stress now and again is perfectly normal. But, when stress and worrying becomes a habit, or when you are constantly faced with a high-pressure work environment, or are having problems at home, the consequences may become more serious than just the occasional headache.
According to Muller, the physical effects of stress may have a detrimental effect on many of the body's systems during long-term exposure (chronic stress), resulting in things such as tiredness, backache, chronic headache, insomnia and indigestion. In short, worrying about a disintegrating marriage for months on end can really make you ill. And it's definitely not just in your mind.
Why we differ
Yet, while one person manages stress symptoms effortlessly, another develops splitting headaches or starts feeling nauseous, differences that cannot be explained by the above.
“The answer may partly lie in the "gene-by-environment" interaction,” says Muller, “That means a person has a specific genetic make-up (as yet unidentified in somatoform disorders) that interacts with certain environmental factors or events (such as stressful life events).
“An example is genetic variations in the serotonergic system (a neurochemical that not only plays an important role in anxiety and depression, but also in the gastro-intestinal system) that moderates emotional responses to stress,” she said.
Thus, something like the death of a loved one, combined with the wrong set of genes, may well trigger a bad case of irritable bowel syndrome.
Yet, it isn’t quite as simple as blaming your genes. As Muller points out, “we lead a certain lifestyle and have learned behaviours and coping styles that also influence our response to stressful events.”
What you can do about it
One solution for people plagued with somatoform symptoms is to get rid of the underlying stressor. But this is often easier said than done. A difficult teenager, a spouse going through a tricky time, or a boss who is being impossible cannot always simply be avoided.
While Muller acknowledges that it is important to treat the underlying problem, she also stresses the value of “healthy coping strategies and intact defence mechanisms.”
But the news is not all bad. Even though you may be unable to change your situation, you can change how you deal with it.
“Pain beliefs and coping strategies have a significant influence on the outcome of somatoform symptoms. For example, a person with ineffective coping strategies may catastrophise - or may be making things worse by focusing too much attention on the symptom/body part,” said Muller.
She points out that things such as breathing exercises and relaxation techniques may be of value to some patients.
Many people become convinced that there is something serious wrong with them and they spend a fortune being told by one doctor after another that they are fine.
“Once known medical causes for a bothersome symptom is ruled out, one should avoid excessive health-seeking behaviour. Unnecessary medical visits, tests and prescriptions all add up to the high health care costs often incurred by somatisation.”
A healthy lifestyle
In addition, Muller points out that health should be looked at holistically.
“Your lifestyle influences your body which influences your mind (which in return influences your body…). It sounds like a cliché, but a healthy diet, exercise and enough sleep will help you function optimally. Daily exercise has been shown to enhance brain regeneration. And a healthy brain can cope better with stress than e.g. a brain that's alcohol-intoxicated,” she said.
She advises staying away from the “uppers and downers”, things such as alcohol, drugs, too much caffeine and smoking.
“And interestingly enough, traditional pain medication is not effective for somatoform pains-and-aches,” she said. “There is actually much literature on analgesic-induced chronic headaches: that means the painkillers causes or aggravates the tension headache in the long run. Thus, reaching for a cigarette or a pain tablet is not the solution. Perhaps you'll be better off spending time on a hobby or getting in some exercise.”
More extreme examples
According to Muller, somatoform symptoms most commonly include tiredness, bodily pain, insomnia, tension headaches, abdominal symptoms (e.g. pain / discomfort or indigestion), and back ache.
Often these symptoms are transient. They may, however, become chronic and impairing, falling under the diagnostic category of somatoform disorders.
“The most commonly diagnosed somatoform disorders are somatisation disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, and pain,” according to the Merck Manual.
Apart from the symptoms outlined earlier, some of these disorders can have strange and severe consequences.
In conversion disorder, patients may experience that a limb becomes paralysed or that they lose their sight or hearing. According to the Merck Manual, the onset of symptoms is generally linked to a distressing social or psychological event.
The affected limb or sense usually returns to normal within a few weeks of treatment. Treatment may consist of psychotherapy, hypnotherapy, or medical assurances that the symptom is not the result of an underlying physical cause. – (Marcus Low, Health24, September 2007)
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