Headaches, tiredness, abdominal complaints and muscle aches are of the most common physical symptoms encountered in primary health care, and may be related to an underlying medical illness.
But often the physical examination and tests turn out normal and the doctor or health professional cannot find a medical explanation for these complaints. Such unexplained physical symptoms (also called somatoform symptoms) may be transient, but can become more enduring with clear impact on a person’s day-to-day life.
As the body and mind are inseparable, medically unexplained physical symptoms may be related to anxiety, depression or stress. For example, when a person perceives danger this message gets relayed to the brain, and the body changes so that it can adapt to survive the threat.
Various brain areas, neuro-chemicals and hormones are involved, with messages being relayed through the spinal cord so that the body can get ready to react (whether it is to flee or defend itself). One becomes more alert, the heart beat accelerates, breathing gets faster, blood flows to the muscles, wound healing is promoted, one’s pain threshold may decrease, and basic needs such as sleeping or eating become less important.
Neuro-chemicals such as noradrenaline and serotonin, as well as cortisol (a so-called “stress hormone”) play important roles in the physical adaptation to acute stress. With prolonged stress these changes however become damaging to the body, and symptoms such as tiredness, headaches, musculo-skeletal pain (e.g. back pain), insomnia, indigestion, and poor attention and concentration may emerge.
Chronic stress may also be linked with cardio-vascular disease (e.g. hypertension), diabetes, cancer, and various other medical illnesses.
It has, however, become clear that aches and pains (e.g. headaches, abdominal discomfort, back- and muscle pain) are also important symptoms of depression and anxiety. For many years psychological symptoms have been the mainstay in the diagnosis of depression and anxiety. For instance, depressed mood, lack of pleasure in life, guilt feelings, low energy, thoughts of death, and sleep or appetite changes were seen as the most important symptoms when diagnosing depression.
Research has, however, shown that almost three out of four people with depression will present to their primary care doctor with only physical symptoms, thereby emphasising that one should be aware of the overlap between mental and physical health, else a treatable condition may end up in many unnecessary tests or referrals to specialists (and no symptom relief for the patient). Some of the same neuro-chemicals (e.g. serotonin and noradrenaline) and hormones (e.g. cortisol) that play a role in stress are also implicated in depression and anxiety.
Although much still needs to be learnt about the complex effects of mental health on physical well-being, and the psychological effects of chronic illness, the inseparable relationship between the body and mind is undeniable.
(Dr Jacqueline Muller, Mental Health Information Centre)