How often do we hear complaints from people of stomachaches, headaches, and muscle tension, such as backaches? These somatic symptoms are some of the most commonly occurring maladies on a global scale. Although they can appear as strictly within the body to both the patient and practitioner, these symptoms often are disguising what is occurring within the mind—psychological distress, including, but not limited to, depression, anxiety, grief, and history of trauma. This is called somatization, defined as the process by which individuals with psychological impairments manifest their emotions into somatic symptoms, which are not due to physical disease.
Those experiencing somatization often seek medical attention, presenting symptoms with a psychological origin in non-mental health settings. Despite how real the pain feels, the symptoms are often without medically confirmed or complementary physical findings. Although the functions of somatization vary based on culture and context, somatic symptoms frequently serve as an expression of the inability to recognize one’s own emotions. The symptoms manifest in an array of physical complaints encompassing a wide range of severities as another way to experience distress while disconnecting from its emotional roots.
Somatization poses a considerable medical, social, and economic issue in society well beyond the patient. It creates an overuse of medical services, including outpatient visits, hospitalizations, and overall health care costs. The severity of these somatic symptoms vary widely, from everyday bodily sensations to extreme disabling and persistent symptoms that make daily functioning a challenge. This can look like the inability to work or steadily hold employment due to debilitating symptoms, as well as juggling numerous doctor’s appointments and unnecessary medical tests. Those who somaticize additionally tend to show difficulty in describing and understanding their experiences, which may reflect limitations with cognitive processing and emotion regulation. Furthermore, as somatization works to protect oneself against emotional pain, these patients typically do not connect their physical symptoms with their existing psychological distress. This can make accurate and effective diagnosing and treatment particularly challenging.
Unfortunately, the lack of brain and body integration within the medical field leads to frequent misunderstanding and mislabeling of somatic symptom presentations. Treatment is additionally challenging, as the patient often recognizes their symptoms as solely in the body and unrelated to their mind and emotions. Consequently, mental health support is often not sought out and, thus, a psychological condition is not identified; the symptom continues to live solely in the body without adequate explanation.
In these situations, the patient may often get trapped in a cycle of bouncing from doctor to doctor, specialty to specialty, balancing a slew of diagnoses without a clear treatment plan or prognosis. Their issues may be deemed as medically unexplained, or they may receive a specialty-specific medical diagnosis that reinforces the idea that the pain is located solely in the body, often ignoring the psychological and emotional underpinnings of the somatic presentation. The current medical diagnostic system is, sadly, not set up in a way for integrative diagnosis and treatment of somatization, and patients often do not seek mental health support for somatic issues as they tend to manifest to avoid one’s psychological distress. In result, the true origin of the somatic symptom is ignored, and subsequently, unable to be fully treated. And the cycle continues.
So, the next time a wave of nausea takes over, or a pounding migraine comes on, reflect on your emotional context. Has anything stressful occurred? Anything psychologically triggering come up? How is work life, home life, family life? Has there been a second to breathe, reflect, and process recent events, or has daily life consisted of adhering to calendar events and endless to-do lists, soldiering on despite feelings of overwhelm and anxiety? It could be a headache, but it also could be more.
Leslie Alter, MA
CORE - Center of Relational Empowerment, PC