Hi friends,
When I see a client for the
first time, I often get this question: “I came here for my chest pain and
headache, not to see a psychiatrist! Do you think I am a ‘psychiatric
patient’??” The scenario often repeats
itself with people presenting with a wide range of other symptoms such as body
ache, leg pain, back pain, vomiting, fainting and so on. So what is this
peculiar presentation? Can psychological problems present with physical
symptoms? Does that mean that the pain is ‘not real’? Does it mean that the
patient is ‘faking’ the symptom? Well, that is what we shall be discussing
today.
It is extremely common for a lot of
people to have physical symptoms that do not have a medical disorder explaining
it. This, however, does not mean that the symptoms are not real. It also does
not mean that the patient is faking the symptom. Unfortunately, these symptoms
are very often considered (and wrongly so) unreal, fake and ‘all in the head’
by laypersons and sometimes physicians too. Psychiatrists often receive
referral from their medical colleagues for such complaints. So how do we make
sense of this?
Psychological problems very often
present with physical symptoms. Without going into a detailed discussion and
medical jargon, it suffices to say that physical symptoms may represent the
only symptoms of a psychiatric condition, part of the symptom repertoire of
conditions such as depression or may represent an exaggerated version of the
symptoms of an underlying medical disorder.
So how can a psychological problem
lead to a physical symptom?
Many
people are unable to accurately identify and label their own emotional state.
For instance, they may be sad, but be unable to acknowledge and identify that
they are sad. All they can make out is that they are feeling uncomfortable and
distressed. But when this distress needs to be conveyed, it often takes the
form of physical sensations (eg. heaviness in the chest) that are associated
with the sadness. In due course of time, excessive attention and magnification
of these bodily sensations (heaviness in the chest) becomes a problematic
symptom (pain in the chest) in itself. Similar explanations also hold true in
situations where one is culturally not expected to show certain emotions and
associated behaviors (men not expected to cry). So the distress gets expressed
in physical terms. But here is the catch! All these processes are
unconscious and the person is often not aware of it!
We are all familiar with the
fact that when we are quite happy, pain does not bother us as much as it does
when we are otherwise distressed or irritated. Thus, psychological problems
interfere with, and often alter the perception of pain itself. This in turn
results in non-painful sensations being perceived as pain or, mild pain being
perceived as severe pain. Also, it is common knowledge that there is a large
inter-individual variation in the tolerance to pain. While a soldier serving
the nation in a war zone can withstand the pain of a gunshot wound, city
dwellers may find it difficult to tolerate pain related to a thorn prick. What
is considered a light touch by one person may feel like a deep pressure to
another. What is considered pressure may be perceived as pain by another. Thus,
the label given by the brain to an incoming sensation varies from individual to
individual, and depends a lot on one’s genetics, upbringing, life experiences,
demands of the situation and many other factors. Sometimes, physical symptoms
provide the only available way of diverting one’s attention from unacceptable
psychological distress/ conflict or handling guilt (physical problems
explaining one’s inability to achieve goals set for himself and resultant
shame/ guilt). Again, these processes are often unconscious!
At a neurobiological level, all
these processes are orchestrated by a wide array of chemical substances
operating within and outside the brain. Medicines often correct these chemical
abnormalities and provide relief from pain. Obviously, the regular pain killers
are not effective in these scenarios!
Thus,
the bottom-line is that it is not only possible but is also extremely common to
see people having seemingly unexplained physical complaints that are actually
part of a psychological problem.
THE
PAIN IS REAL AND THE PERSON IS NOT DELIBERATELY FAKING IT. SUGGESTING THAT HE/
SHE IS FAKING IT WILL ONLY WORSEN THE CONDITION!
So
the right approach is to look at these symptoms as a sign of distress and
evaluate it in a non-judgmental manner. A judicious combination of
psychotherapy and medicines often works best in these scenarios.
So
that was the discussion for this week friends. Hope you liked it!
Please let me know if you want me to
discuss any specific issue by typing in the comments section below.
Write in at stayhappy.prakash@gmail.com
So until next time, STAY HAPPY!
Dr. Sathya Prakash, MD, Dip. CBT
Consultant Psychiatrist, Psychotherapist
and Behavioural Sciences Expert
Well written sir
ReplyDeleteI think this is also known as somatization ???
ReplyDelete