Am I really sick or is it all in my head?

The term ‘psychosomatic’ combines two Greek words, psykhe (psyche/ mind) and somatikos (somatic/ body). It describes physical symptoms that either originates from or are aggravated by psychological factors like anxiety and stress rather than a specific injury or infection. They manifest as physical pain or distress of varying intensity and can significantly affect different areas of a person’s life. Psychosomatic illnesses are not imaginary; they are real and require treatment, observations, and follow- up, just like any other illness.

Women tend to report more symptoms concerning emotional stress than males while men are more likely to report symptoms like chest pain, muscle tension, changes in sex drive. Symptoms of stress in children may show as new or recurrent fears, being clingy, inability to regulate their emotions. Teenagers experience more intense levels of stress, having to deal with hormonal changes, social expectations, and pressure. So, it is important to pay attention to the warning signs of stress like increased irritability, negative behavioural changes, and not just write them off as teenage rebellion.

If you are caring for an elderly loved one and get upset over the seemingly unfounded physical symptoms they complain about, please cut them some slack. The ageing population are more socially isolated, more likely to have chronic diseases and worry about the end of life while dealing with the grief of losing peers and other loved ones. They are increasingly prone to depression and it can manifest as physical symptoms like aggression. A 75-year-old man who lives alone, depends on relatives for daily life activities like bathing, eating, whose children barely visit due to tight work schedules may express feelings of frustrations as physical aggression, or chronic pain for example.

Psychosomatic disorders may present with

Nausea, vomiting, hiccups, heartburn, peptic ulcer, loss of appetite, constipation, irritable bowel syndrome.
Breathlessness, dizziness, asthma, migraine, tension headache.
Chronic itching or scaling skin, sudden hair loss, chronic inflammatory diseases.
Back ache, muscle pain.
Menstrual and urinary disturbance, erectile dysfunction, painful sexual intercourse.
Physical aggression

Every disease has its management strategy and treatment options. Since psychosomatic disorders involve two principal aspects, the mind and the body, management should also target these areas. For mild cases, the consulting physician can offer reassurance; investigations considered safe for the person’s clinical and physical state can also abate symptoms. Medications can be used to reduce anxiety and tension, but this has to be administered carefully because of the risk of addiction and tolerance.

Talking therapy, also known as psychotherapy, gives room for the individual to freely share life’s events and experiences and their mental status. It will help the doctor to analyze the mental illness the individual is suffering from and provide the appropriate therapy. Cognitive behaviour therapy focuses on the individual’s thoughts, beliefs, and their impact on their mental condition. The number of sessions required depends on the severity of the individual’s symptoms, and it also helps to overcome negative situations that altered their behaviour. Other helpful management strategies include group psychotherapy, exercise, and lifestyle changes.

Similar terms are:

Somatoform disorder- in this case the complaints are exaggerated and investigations either show nothing to support the physical signs and symptoms or show minimal findings.
Somatization disorder- here there are multiple longstanding symptoms usually starting before the age of 30 years, and the symptoms have limited or no supporting medical evidence.