Psychosomatic Symptoms

Psychosomatic symptoms are real physical symptoms, such as headaches, chest tightness, stomach upset, pain or tiredness, that are caused or made worse by stress, anxiety, depression or trauma rather than by injury or infection. “Psychosomatic” means involving both mind and body. The symptoms aren’t imagined, and they respond to treatment.

Also called: somatic symptoms; medically unexplained symptoms or persistent physical symptoms, the terms doctors now prefer; somatisation. When the worry about the symptoms takes over life, the clinical labels are somatic symptom disorder (the US manual) and bodily distress disorder (WHO’s ICD-11).

Signs and symptoms

The commonest are:

headaches, and pain in the back, muscles or joints
tiredness that sleep doesn’t fix
a racing or pounding heart, chest pain or tightness
stomach problems: nausea, cramps, diarrhoea or constipation
dizziness, feeling faint, numbness or tingling

Less often: breathlessness, weakness, or episodes that look like seizures. Tests come back normal, which can make the symptoms more frightening, not less. About 1 in 4 people who see a GP have symptoms that can’t be medically explained.

Causes

Stress and strong emotion change the body: muscles tense, the heart speeds up, digestion slows, sleep breaks, and pain feels sharper. Kept up for weeks, those changes become symptoms of their own. Many people with unexplained symptoms also have depression or anxiety, and treating that often relieves the symptoms. WHO’s primary-care guide lists multiple persistent physical complaints with no clear cause as a common way depression presents, and in some people it shows mainly as a racing heart, a tight chest or constant headaches. The loop runs both ways: physical symptoms cause worry and low mood, which make the symptoms worse.

Treatment

A doctor first. Medical causes have to be ruled out, including medicines you already take. Long-term painkiller use, for example, can itself cause headaches.
Treat the stress, anxiety or depression underneath, with talking therapy and, if a doctor advises, medicine.
CBT helps you see the links between symptoms, worries, feelings and what you do about them, and loosens the loop.
One consistent doctor who takes the symptoms seriously, rather than round after round of new tests.
Regular activity, regular rest and regular sleep.

In Nigeria

In Nigeria, distress often arrives at the clinic in the body. WHO’s diagnostic manual names “heat in the head”, crawling sensations and heaviness as common ways people describe anxiety and depression in some cultures. Nigerian studies agree: in rural south-west primary care, about 1 in 5 adults reported heat, “peppery” or crawling sensations or numbness, and those symptoms tracked distress. In an Ibadan clinic, anxiety and depression most often came with widespread body complaints. In a Lagos survey of 11,246 adults, depression and anxiety symptoms were strongly linked with body symptoms. Students have long described “brain fag”: headaches, poor concentration and poor sleep tied to study. The experience is real; most psychiatrists treat it as anxiety or depression.

People with many body symptoms often see a traditional or faith healer as well as a doctor. Whoever you see first, it’s worth asking whether stress, worry or low mood might be part of the picture.