Medically Unexplained Physical Symptoms

  • ­Have you been suffering from physical symptoms for which there seem to be no effective treatments?

  • Have you seen multiple specialists without any conclusive findings?

  • Are you experiencing emotional stress that might be contributing to your medical symptoms?

If the answer to any of these questions is “yes,” I may be able to help. I specialize in treating Medically Unexplained Physical Symptoms (MUPS).

 

It’s well known that physical symptoms can result from unconscious emotional conflict. The emotional center of the brain is intricately connected with important structures and systems within the body — the skeletal system, the voluntary muscles that control movement, and involuntary muscles such as the smooth muscles that line the stomach, bronchi, and urogenital center. The fight-or-flight reaction, so essential to our survival, depends on these interconnections. But these same connections can convert the anxiety generated from our emotional reactions into many different physical symptoms that cannot be explained by medical examination. The conversion of emotional conflict into physical symptoms is called somatization. In the medical field these disorders are referred to as Medically Unexplained Physical Symptoms (MUPS).

Some of the most common MUPS include:

  • back pain

  • fibromyalgia

  • Irritable Bowel Syndrome (IBS) or functional dyspepsia

  • migraine and tension headaches

  • hypertension

  • Tension Myositis Syndrome (TMS)

  • Complex Regional Pain Syndrome (CRPS)

  • neurological symptoms (e.g., blurry vision, dizziness, tingling or numbness in arms and legs)

  • rashes or itching

  • Erectile Dysfunction (ED)

  • pelvic pain, Urethral Syndrome

  • Chronic Fatigue Syndrome

Continued —

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[1] Abbass, A. Kisely, & Kroenke, K. (2009). Short-term Psychodynamic Psychotherapy for Somatic Disorders: Systematic review and meta-analysis of clinical trials. Psychotherapy and Psychodynamics, 78, 265–274.

[2] Abbass, A. (2005). Somatization: Diagnosing it sooner through emotion-focused interviewing. The Journal of Family Practice, 54, 215–221.

[3] See more research on somatic disorders at The Center for Emotions and Health, Dalhousie University Web site.

For more information about medically unexplained physical symptoms and their treatment, see:

Sarno, J. (2007). The Divided Mind: The Epidemic of Mindbody Disorders. New York: Harper.

Unfortunately, many patients suffer for years with physical symptoms without psychological intervention, resulting in unnecessary medications, tests, operations, and hospitalizations. Somatization is not an obscure phenomenon afflicting a few unfortunate individuals. In fact, almost everyone has experienced somatization at some point in their lives. If you have ever thrown up (or come close) from anxiety or gotten a headache from stress, you have experienced somatization. When these reactions are isolated and infrequent it is usually not a cause for concern. However, if this pattern of converting emotions and anxiety into physical symptoms becomes chronic, it can cripple people’s ability to enjoy life. Naturally when this occurs people seek medical attention. Half of all primary care visits are related to somatic complaints. One-third to one-half of these patients leave their doctor’s office with no medical explanation for their symptoms.[1] Even worse, many patients leave the office feeling dismissed or even told “it’s all in your head.” And not knowing what is causing the symptoms—or having them dismissed as imaginary--can create additional stress.

 

In treating MUPS it is essential for psychologists and primary care physicians to work together, both to rule out underlying medical issues that could cause physical symptoms and to evaluate the possibility that a patient is experience MUPS. Fortunately today’s medical practitioners are moving away from the view that somatic disorders are chronic and incurable conditions for which they offer only support and solace. Research over the past 30 years on the effectiveness of psychotherapy for somatic disorders has brought new attention to the interplay between the mind and body, and particularly the effect of unconscious emotions on somatic conditions, and as a result we know a lot more today about how emotional conflict translates into physical symptoms.

 

We know, for example, that many people with somatic disorders have been traumatized or mistreated by someone close to them. Feelings of anger toward the abuser, usually unconscious, can create emotional conflict that leads to anxiety. The anxiety causes individuals to develop defense mechanisms to ease these feelings or put them out of awareness. The internalization of anger appears to be a common thread in many somatization disorders, including IBS, hypertension, fibromyalgia, and migraine headaches. Similarly, blocking other emotions, such as sadness and grief, can also cause somatic symptoms.

 

Since the 1980s many research studies have documented the effectiveness of Intensive Short-term Dynamic Psychotherapy (ISTDP) for the treatment of different somatic disorders.[1][2][3]  Because the emotional conflicts that contribute to somatic disorders are usually out of the individual’s conscious awareness, ISTDP’s focus on bringing unconscious emotional conflict into awareness and working through underlying conflicts may explain why this approach has proved so effective with somatic disorders.

 
 
 
 

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Stuart Andrews, Ph.D. provides psychotherapy to individuals, couples, children, and adolescents. Dr. Andrews specializes in ISTDP and PACT counseling. He can help with concerns including depression, anxiety, relationship issues, procrastination, personality disorders, trauma and abuse, and Medically Unexplained Symptoms (MUPs), also called Tension Myositis Syndrome (TMS) or Psychophysiologic Disorders (PPD). His office is located in Reston, VA (near Alexandria, Arlington, Ashburn, Burke, Centreville, Chantilly, Fairfax, Great Falls, Herndon, McLean, Oakton, South Riding, and Vienna, VA; Silver Spring and Bethesda, MD; and Washington, DC).

 

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