The connection between the mind and body is fascinating. In medical practice, understanding this connection is incredibly important. Understanding that emotional states can impact our physical health and can even cause illness is important. It is the basis of psychosomatic disorders.

In this article, we explore the nature of psychosomatic disorders, the importance of listening to patients, and a different approach for patients whose diagnosis is not so black and white.

What is a psychosomatic disorder?

A psychosomatic (‘psycho’ meaning mind and ‘somatic’ meaning body) disorder is an onset of physical symptoms/illness induced or aggravated by intense psychological changes, such as stress or trauma.

Psychosomatic disorders are largely overlooked, mostly due to the difficulties surrounding their diagnosis and treatment. Nonetheless, they are a reality for some individuals. They take much time, resources and patience to understand and work through.

What are some symptoms of psychosomatic disorders?

Psychosomatic disorders can trigger or give rise to different symptoms and illnesses, both physical and mental.

These include:

• Irritable bowel syndrome (IBS)
• Eczema, psoriasis
• Chronic pain
• Asthma
• Chronic fatigue
• Anxiety
• Depression
• Asthma

Psychosomatic disorders are often dismissed and can be labelled ‘all in the head’ due to the absence of an obvious tangible cause. In fact, the symptoms are very real, and can often be debilitating to the patient. If you feel like you are struggling with a psychosomatic disorder, or are struggling with any symptoms,  make sure to reach out your doctor or mental health professional as soon as you can.

It’s astounding to see how emotional health can contribute to the manifestation of such symptoms and diseases. But how can psychological stress cause this?

The impact of psychological stress

Intense psychological experiences such as significant changes in life, trauma and/or chronic stress can induce changes in your body.

The effect of stress on the body on a biological level is explored in our previous articles. Here we discuss how being mindful and lowering stress can help with our immune responses. Studies have indeed confirmed that people who are chronically stressed exhibit compromised immune responses.

Following this line of thought, people who have experienced immensely stressful events in life or are chronically stressed may have deeper psychological impacts which can affect their physical health.

Dr. Bessel van der Kolk, a psychiatrist and trauma researcher, discusses this in detail in his fascinating book: ‘The Body Keeps Score.’ Here, he runs through his personal experiences as a trauma doctor. He discusses in detail the ways in which the deep trauma of his patients had an effect on both their physical and mental health.

Understanding how this happens can be key in treating trauma patients.

Linking the brain and body

There are still many questions regarding the exact biological mechanisms by which psychological stress induces physiological responses.

Since the 1950s, the field of neuroscience (the study of the brain and nervous system), has expanded immensely. It has emphasised not only the complexity and fascinating nature of the human nervous system but also the essential part it plays in maintaining important bodily functions.

A neuroscientific attempt to clear psychosomatic confusion

The nervous system is an elaborate network controlling all the different processes in our body. This includes processes that are involuntary (e.g., breathing, digestion) and voluntary (e.g., moving).

Understanding the nervous system and its relationship with stress may help to clarify how emotional states can dictate our physical well-being, i.e., how it may cause psychosomatic disorders.

Studies have shown that the vagus nerve, a key part of our nervous system, is directly involved in mediating a multitude of processes in our body. However, overwhelming amounts of stress can over-activate the nerve, causing symptoms such as abdominal pain and sickness, and it has even been linked to anxiety and depression.

Studies have also shown the deep impacts that trauma in particular can have on the vagus nerve, leaving a patient in a constant state of flight or fight. To treat this, studies look at carrying out practices to ‘reset’ the vagus nerve.

. This can help allow a more adequate regulation of the body’s stress response.

Despite the progression in neuroscience, there is still an immense grey area regarding psychosomatic disorders in the clinic, making it difficult for doctors to treat patients.

Psychosomatic disorders in the clinic

Doctors sometimes do not know how to diagnose or deal with psychosomatic disorders. This could be due a lack of education on the concept, the segregation of medical specialities (psychiatry in particular), and a lack of holistic healing when dealing with a patient.

Patients experiencing psychosomatic symptoms have consistently been overlooked and misdiagnosed, with symptoms being treated as short-term fixes when no identifiable root cause is found. In terms of dealing with psychosomatic disorders in the clinic, reviews and studies emphasise the importance of patient-centred care.

This includes first and foremost, actively listening to the patient.

The art of listening

A narrative piece called ‘Please Hear What I’m Not Saying. The Art of Listening in the Clinical Encounter’ highlights the importance of truly being present for a patient and listening to their concerns.

‘If you listen long enough, the patient will give you the diagnosis’ – Sir William Osler (known as the father of medicine)

The article describes a doctor‒patient relationship as being ‘unique’ and ‘powerful’, with a type of closeness that doesnt exist in any other relationship, owing to the patient’s immense vulnerability. The discussion highlights how impactful the feeling of being heard is for a patient. Moreover, the importance of acknowledging a patient’s pain and offering words of reassurance is priceless in the clinical setting.

Positive affirmation can decrease the stress levels of a patient, keeping them in a place where they feel safe to express their symptoms freely and without judgement. In the context of patients with psychosomatic disorders, this is particularly important considering the already present psychological sensitivities.

Another review published in MDPIs Healthcare discusses how factors like strict adherence to clinical guidelines and financial pressures can hinder the ability of a doctor to use their best medical judgement when making a diagnosis.

Although guidelines are essential for clinical practice, they work with a disclaimer that a doctor’s own judgement is essential for each unique situation. No two patients are the same, even if both present very similar symptoms. The importance of exploring the right avenues for diagnosis depends on the patient’s ‘story’.

This emphasises the importance of a holistic approach to healing.

Holistic treatment for psychosomatic disorders

An alternative service for patients with a psychosomatic disorder is psychosomatic medicine. This type of practice integrates the treatment of not only physical symptoms, but addresses the emotional, physical and social aspects too. Because of this multifaceted approach, psychosomatic medicine is described as being holistic. It works to move away from treatments based solely on an isolated set of physical symptoms.

The practice uses the patient as a partner in their own healing processes, especially in the case of people who have experienced trauma. It encompasses deep psychological rehabilitation to work through their body’s chronic stress responses. It does not dismiss clinical medicine, but acts as a bridge, urging the importance of addressing the mental and social well-being of patient, as well as the physical.

Future outlook

Research on psychosomatic disorders continuously progresses, as the field of neuroscience accelerates along with our understanding of emotional health and trauma research.

Approaching healthcare with a type of openness is key, especially when there is no obvious cause for the illness in a patient. Listening and acknowledging a patient’s worry and considering the impact of emotional and social stress can be immensely beneficial for both the patient and the doctor in terms of reaching a diagnosis in the most efficient way possible.

MDPI publishes papers exploring all aspects of medicine including psychology and behavioural sciences. If you would like to read more or publish your novel research, please see MDPI’s full list of journals.