There are strong indications that people with psychological trauma often experience unexplained physical discomfort or pain. Unfortunately, this can lead the patient to unnecessary medical care: repeated trials that do not work, prescription drugs without relief, and even unnecessary hospitalizations and surgeries that can impair quality of life and drain them. Failure to find relief from physical ailments can cause further anxiety for the person and create feelings of weakness, depression and anxiety.
It is important to understand that bodily trauma symptoms can be treated. If you are experiencing chronic pain or other physical symptoms that your doctors were unable to explain, you may want to see a therapist to talk about what may be emotionally disturbing. Some people are not used to talking about their emotions and may be wondering how psychological therapy can possibly reduce physical symptoms. However, there are many recorded cases demonstrating how treatment can alleviate the unpleasant and unexplained physical symptoms.
Two case studies
Around the beginning of the 1900s, psychologists began linking certain cases of paralysis, epilepsy, convulsions and pain to underlying emotional disorders and psychological conflicts. Freud called this phenomenon "hysteria."
The case of Anna O. is an early example of psychological distress manifested as physical symptoms. Anna was a 21-year-old woman who developed a series of physical symptoms after caring for her deceased father. Starting with a severe cough, her illness progressed to limbs on the right side of her body. She has developed disorders in her vision and hearing that have progressed to the point of temporary blindness and deafness. Anna also developed hallucinations, phobias and high anxiety states.
If we have suffered trauma, anxiety and disorders will be expressed in some way. The trauma can find expression affecting the body in the form of unexplained physical illness or pain.The treatment for Anna began with a new approach for that time. Instead of focusing on helping Anna correct her behavior, her doctor intended to help her "roll out" the oppressed mental stress. She encouraged him to talk about what she was going through and to express herself. Anna eventually made a complete recovery and described her treatment as "speech therapy".
A more recent case is discussed in Gordon Turnbull's book Trauma: From Lockerbie to 7/7: How trauma affects our minds and how we fight back. In the book, a 35-year-old woman suddenly couldn't walk or feel her legs anymore. Without bodily injury, the nurses believed he was suspicious.
After extensive interviews, her doctor learned that the woman had been sexually assaulted by someone she knew. The "intolerable mental conflict" was pushed out of her conscious awareness in order to protect her from emotional distress. However, talking about her experience repeatedly allowed her to feel relief. Two days later, she came out of the hospital with her two legs.
Physical symptom disorder and conversion disorder
Today, we no longer have the diagnosis of people with hysteria. Physical symptoms without physical cause are often diagnosed as a physical symptom disorder (SSD) or conversion disorder. A person with SSD may have symptoms that impede the body's ability to function but do not show signs of illness or injury. Conversion disorder occurs when emotional discomfort turns into neurological symptoms such as tremor.
If a person has physical symptoms that cannot be explained, they should always see a physician to rule out diagnoses. If the medical team cannot discern a natural cause for the symptoms, it may refer the person to a therapist. A trained mental health professional can read the person for SSD or conversion disorder.
Criteria for physical symptoms include:
- One or more physical symptoms that are frightening and interfere with functioning.
- One person has been consistently symptomatic for at least six months. (These symptoms may come and go, but there is at least one symptom present at any one time.)
- Excessive or time-consuming behaviors related to physical symptoms.
- Constant thoughts or concerns that are disproportionate to the physical symptoms.
- High levels of stress for health.
Criteria for conversion disorder include:
- Neurological symptoms such as weakness, paralysis of limbs or problems with balance.
- Non-response episodes.
- Difficulty swallowing.
- Difficulty walking.
- Other aesthetic interruptions or symptoms, such as hearing loss, blurred or double vision, episodes of blindness, speech, speech impairment and numbness.
Cognitive behavioral therapy (or a combination of cognitive behavioral therapy and antidepressants) has been shown to reduce the symptoms of SSD and conversion disorder. Treatment can also treat the underlying trauma and improve emotional well-being.
Why therapy helps
Part of Freud's important discoveries were that unpleasant and disturbing memories are not removed. If we have suffered trauma, anxiety and disorders will be expressed in some way. The trauma can find expression affecting the body in the form of unexplained physical illness or pain.
Treatment allows wound healing. It provides a safe environment to express old hurts and fears so that healing can begin. Treatment can also teach trauma victims healthy ways to deal with it. Together, this not only allows the individual to express their current discomfort but also to implement coping strategies that ultimately reduce emotional distress.
In other words, treatment does not address physical symptoms at the surface level. On the contrary, it usually treats the symptoms in the context of the unresolved composite trauma.
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- Anna O: The story of Sigmund Freud. Psychologist World. Retrieved from https://www.psychologistworld.com/freud/anna-o-case-study-freud
- International Society for the Study of Trauma and Isolation. (2011, March 3). Guidelines for the Treatment of Adult Identity Disorder, Third Revision. Trauma & Dissociation Magazine, 12(2), 115-187. Retrieved from https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
- Kallivayalil, R.A. & Punnoose, V.P. (2010). Understanding and managing somatoform disorders: Ensuring a sense of meaninglessness. Indian Journal of Psychiatry, 52(Suppl1), 240–245. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21836685
- Nicholson, C. (2017). Because Freud was right in the hysteria. The conversation. Retrieved from https://theconversation.com/why-freud-was-right-about-hysteria-86497
- Patient history: Physical symptoms disorder. (n.d.). Retrieved from https://www.psychiatry.org/patients-families/somatic-symptom-disorder/patient-story
- Rosic, T., Kalra, S., & Samaan, Z. (2016, January 12). Physical Symptom Disorder, New DSM-5 Diagnosis of an Old Clinical Challenge. BMJ Case Reports. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26759438
- Turnbull, G. (2011). Trauma: From Lockerbie to 7/7: How trauma affects our minds and how we compensate. New York, NY: Random House.
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