by Edward Bruce Bynum, Ph.D., A.B.P.P.
Director of Behavioral Medicine
Bodily discomfort of one kind or another is a relatively common experience. These experiences are usually transient in nature and associated with either reactive stress, illness, or an obvious injury. Somatization however is not the same as mere bodily discomfort. Somatization is an episodic or ongoing interaction with the body, mind and anxiety. Somatization may involve medical or other distinct physical symptoms. It is highly associated with the dynamic presence of anxiety and the psychological capacity to change, shift or convert this anxiety into physical symptoms.
Some of the more common examples of somatization include three of six different kinds of headache; muscle contraction, the two varieties of migraine headache, and the mixed headaches. They are not generally associated with sinus, cluster or neurological headaches. Some are psychosomatic in origin while others are medical in origin but greatly exasperated by anxiety. Various annoying gastrointestinal disorders are highly associated with the process of somatization. These include the symptoms of irritable bowel syndrome, colitis, esophageal reflex syndrome, and various sites of GI tract ulcers. In the area of respiratory disorders, somatization is associated with the symptoms of both asthma and rhinitis. This is not to say that all asthma is a result of somatization. Some asthmas are the result of either environmental toxic reactions and in some cases congenital respiratory sensitivities. However, there is a clear association in a large percent of asthmatic situations with stress and respiratory distress.
In adults, genitourinary problems are expressed primarily in the areas of sexual dysfunction. In particular, the difficulties men experience with either premature or retarded ejaculation or various other erectile functions (ED) but not associated with a primary medical problem are highly correlated with the phenomena of anxiety and somatization. In women, the symptoms of vaginismus, dyspareunia, and various forms of what has been know historically as “frigidity” are associated with anxiety, somatization and in some cases trauma. In physically healthy men, both primary and secondary impotence are highly associated with anxiety and somatization, particularly performance anxiety. These sexual issues are deeply infused with familial and interpersonal dilemmas as well as social-political dynamics. Therefore, one must proceed with caution in working with a clinician in these areas to get an accurate assessment.
In the area of dermatological complications, somatization can express itself in the phenomena of hyperhidrosis, or excessive sweating, dry skin or psoriasis, or even hives. In the area of cardiovascular problems, somatization is most expressive in the various forms of arrhythmias or irregular heartbeats, Raynauds disease and Raynauds phenomena, which is decreased blood flow to the hands and feet, and Burgers disease. The two varieties of migraine headache are cardiovascular disorders highly associated with phenomenon of somatization.
From ancient times until now, the phenomena of somatization has been associated with the experience of prolonged and acute anxiety. Clinicians have noticed an increase in somatic symptoms concomitant with the increase in anxiety. However, it has also been observed that chronic depression and a sense of hopelessness can either greatly exacerbate existing symptoms or actually create various forms of somatization. The dynamics of somatization very often are parallel to other psychological events, especially the experience of dreaming. By this is meant that both somatization and dream phenomena emerge from the unconscious and involve the dynamic process of displacement, localization, and symbolization. This is not such a striking notion when we consider that both dream life and most of our physical and somatic life, of necessity, is lived in the regions of the unconscious. It is also in the regions of the unconscious that our shared family dynamics have their deepest roots. This is why family oriented clinicians have noticed that symptoms of a somatic variety seem to be learned and unconsciously modeled within the family context.
Many benefits do accompany various forms of somatization. “Secondary gains” for being ill can exercise control or influence in the family, relationship or work situation. Also there are emotional and sometimes financial benefits for malingering and hypochodriasis. Hypochondriasis however should not be identified with a hysterical neurosis or fictitious disorder. Hypochondriasis is that constant preoccupation with usually minor physical complaints and shape-shifting medical disorders. Often in hypochondriasis there is not a clearly identified or stable medical disorder. In the case of hysterical neurosis, a powerful emotional conflict is expressed in a bodily symptom. One of the most dramatic, of course, being an hysterical pregnancy. One can also actually be physically pregnant but in psychotic denial despite the obvious medical situation. Finally, in the case of fictitious disorder, a person actually creates a medical problem that may require medication or even surgery for the secondary gains attended to it.
Various “vague symptoms” are also associated with somatization. These vague symptoms many times do have a medical basis, however there is not always a one-to-one correspondence between the intensity or severity of the symptoms and the person’s life context. An example is the Epstein-Barr phenomena. Another is chronic fatigue syndrome. Both of these have some root in physical medical causes but are greatly exacerbated by psychological conditions.
What is generally helpful in these conditions is not intense medical intervention, sometimes this can actually make things worse. Rather it may be other sound, tried and true remedies. For instance a sound, regulated diet can be extremely helpful. This includes a decrease or a moderate intake of “junk food”, and moderate to light alcohol use. Many healthy distractions will decrease stress and anxiety. Meditation and prayer are also helpful. Moderate exercise can not be out done, nor can mini-relaxations during the day. A regulated satisfying sleep life is of great value in moderating and influencing one’s metabolism and emotional state, which has a profound effect on decreasing the tendencies towards somatization. Many diseases are born in the “dis-ease” of emotional and sleep life. Finally, real emotional contact with friends and confidants helps us feel grounded and connected. This will very often decrease anxiety.
There are times however, when the above remedies are not as useful and it is warranted to seek a professional consultation. This is especially the case when there are specific, recurrent somatic complaints over at least a 2-3 week period. The sudden onset of unusual symptoms warrant contact with a healthcare provider. Bleeding or other bodily discharges should be a source of immediate concern and a healthcare practitioner sought out. In all of these circumstances, it is best to see a physician or nurse practitioner first. Consultation with the University Health Services is the fastest and easiest way to go. Based upon their evaluation and your experience, it may then be helpful to see a clinician in the Mental Health division Health Services. This clinician at the Health Services may first recommend a classical and purely medical intervention. This may be diet, moderate exercise, decrease in alcohol and other substances, and regulated sleep. They may also recommend the above and also some brief counseling and therapy for anxiety decrease. In certain specialized situations they may refer you to the behavioral medicine and biofeedback clinic, where the possibility for learning self-regulation strategies and/or clinical hypnosis may be the treatment of choice.
Ader, R. (ed) 1981. Psychoneuroimmunology. New York: Academic Press.
Bynum, E.B. 1994. Transcending Psychoneurotic Disturbances. Ithaca, NY: Haworth Press.
Minuchin, S., Rosman, B.L., and Baker, L. 1978. Psychosomatic Families. Cambridge, MA: Harvard University Press.
The information provided in this column is for educational/information purposes only. The intention is not to provide medical advice or replace the services of a trained healthcare professional. Please take specific issues or medical concern to your healthcare provider. For further information please visit the UHS Mental Health web page at www.umass.edu/uhs/mentalheath.