Psychosomatic illnessesHow the body becomes ill from psychological stress, and how it is treated

8What are psychosomatic illnesses?

A stomach that churns before every exam, a headache that sharpens with every quarrel, a rash that comes back in stressful periods. Many people know this link from experience, and science now explains how it happens and why treating it takes two kinds of doctors, not one.

The word “psychosomatic” joins mind and body, and describes conditions in which the two interact: psychological stress causes or worsens physical symptoms, and physical illness in turn increases anxiety and depression. Modern medicine does not treat these illnesses as a separate category, but sees the psychological factor as influencing most illnesses to varying degrees. Still, there are cases in which this influence is clear and large, and these are what people usually mean by psychosomatic illnesses.

9How does psychological stress affect the body?

When the brain senses a threat it switches on the emergency system: adrenaline is released, so the heart speeds up, blood pressure rises and muscles tense, then cortisol is released, which alters blood sugar and immunity. This is useful for minutes, but when stress lasts for months the body stays on alert: muscles stay tense, the digestive system, which is linked to the brain through the “gut-brain axis,” is affected, inflammation increases and sleep is disturbed. You can find more detail in the guide to psychological stress.

10Examples of psychosomatic illnesses

11Are psychosomatic illnesses imaginary?

No. This is the most common misunderstanding. Irritable bowel causes real pain, eczema really shows on the skin, and high blood pressure is measured by a device. The difference is that the psychological factor is part of the cause, and therefore part of the treatment. Saying “it's psychological” to a patient to mean “there's nothing wrong” hurts them and delays their treatment.

12How do they differ from illness anxiety and hysteria?

• Psychosomatic illnesses: a clear physical illness or real physical symptoms, made worse by stress.
• Illness anxiety (hypochondriasis): the main problem is the fear of having a serious illness, despite normal test results.
• Conversion disorder: neurological symptoms such as paralysis or seizures without any organic disease of the nerves.
• Somatic symptom disorder: distressing physical symptoms with excessive preoccupation with them and anxiety that consumes life.
• Psychological shortness of breath: why some people feel suffocated with anxiety even though their lungs are healthy, and how it is treated.

13When should you suspect a large psychological factor?

• Symptoms clearly worsen in stressful periods and ease on vacation.
• Tests do not fully explain how severe the symptoms are.
• Accompanying anxiety, depression or insomnia.
• Symptoms move between more than one body system.
• Improvement with relaxation, exercise or talking about the problem.
• A history of stress or trauma before the symptoms began.

14Treatment of psychosomatic illnesses

The most effective treatment works on both sides together: medical treatment for the physical symptom and psychological treatment for stress and anxiety. Among the most studied approaches are cognitive behavioral therapy, relaxation and breathing techniques, gut-directed hypnotherapy for irritable bowel, regular exercise, and better sleep. The doctor may prescribe small doses of some antidepressants because they ease pain and gut sensitivity even without depression. Analyses of studies have shown that psychological therapies and antidepressants clearly improve irritable bowel symptoms.