This article explores psychosomatic disorders and compares that to being a hypochondriac, as well as having a complex medical disorder yet to be diagnosed.
As a pharmacist with a passion for understanding how the body works in harmony—or sometimes in disharmony—with the mind, I find psychosomatic disorders to be an illuminating topic. These conditions demonstrate how stress, emotions, and unresolved trauma can lead to real, physical symptoms. This is different than what a hypochondriac experiences.
Psychosomatic disorders involve real physical symptoms, such as chronic stomach pain, caused by extreme stress, or maybe a panic attack… but medical tests may not find a clear disease to cause it. A hypochondriac, on the other hand, experiences normal sensations like mild bloating and become convinced they have something serious like stomach cancer, despite reassurance and negative test results by the gastroenterologist.
I believe we should categorize a third mind-body connection beyond those two (the psychosomatic disorders and hypochondriasis). The third being complex diseases that are not diagnosed yet. So for those pf you suffering with a complex disease that is NOT psychosomotic there is more information for you at end of my blog.
For now, let’s focus on the psychosomatic issues:
Examples of psychosomatic symptoms:
- Chest pain when you’re anxious (but your heart is fine).
- A rash that flares up during an argument.
- Acute pain in a part of your body without injury.
- Diarrhea or cramps.
Today, let’s explore the clinical side of psychosomatic disorders, shedding light on how they occur and how we can approach them with empathy, science, and practical solutions.
The Mind-Body Connection: More Than a Metaphor
The term “psychosomatic” refers to physical symptoms caused or worsened by mental or emotional factors. This connection is backed by extensive research. For example, heightened stress triggers the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol and adrenaline levels. Over time, this state of hyperarousal can result in systemic inflammation, chronic anxiety, cardiac compromise, and worsening autoimmune conditions if you happen to have them (ie rheumatoid arthritis, psoriasis and alopecia areata).
Take migraines as a different example. While vascular changes and neurotransmitter fluctuations play a role, chronic stress is often the trigger that flips the switch! Beta-blockers like propranolol, commonly prescribed for migraines, can mitigate the physiological response to stress but the true solution lies in finding out what your MIGRENADE is.
5 Examples of Potentially Psychosomatic Illness
In each of the following disorders, the symptoms are real, it is NOT in your head. The underlying causes for these conditions involve a complex interaction between the brain, body, and emotions. These conditions remind us how deeply connected mental and physical health are.
1. Irritable Bowel Syndrome (IBS)
- What happens? Stress and emotional distress can disrupt the gut-brain axis, leading to symptoms like abdominal pain, cramping, diarrhea, or constipation.
- Example: A person with chronic anxiety may notice worsening IBS symptoms before a big presentation, even though no infection or structural issue is present.
However, IBS can also result from undiagnosed food allergies, such as gluten or lactose intolerance, or underlying conditions like small intestinal bacterial overgrowth (SIBO). In these cases, the problem would not be classified as psychosomatic, because the symptoms stem from a definable physical cause—just one that hasn’t been identified yet.
2. Tension Headaches
- What happens? Emotional stress causes muscle tension in the neck and scalp, resulting in dull, aching headaches that can last hours or even days.
- Example: Someone under chronic work stress might develop recurring headaches, which intensify during particularly tense moments.
On the other hand, tension headaches could be triggered by poor posture, neck strain, or eye strain from prolonged screen time. If the cause is physical, such as improper desk ergonomics, the headaches wouldn’t be classified as psychosomatic, even if they occur during stressful times.
3. Chronic Fatigue Syndrome (CFS)
- What happens? Persistent, unexplained fatigue, which doesn’t improve with rest, can result from a combination of physical and psychological factors, including emotional stress and trauma.
- Example: A person recovering from intense emotional burnout may feel extreme fatigue despite normal test results.
However, it’s important to consider potential undiagnosed medical conditions such as thyroid dysfunction, adrenal insufficiency, or post-viral syndromes like long COVID. In cases where the root cause is eventually identified, the condition is no longer classified as psychosomatic but rather a physiological disorder.
4. Functional Neurological Disorder (FND)
- What happens? Neurological symptoms like tremors, weakness, or non-epileptic seizures occur without evidence of structural damage to the brain or nerves. FND is thought to result from miscommunication between different areas of the brain.
- Example: A person experiencing severe emotional distress might develop unexplained tremors or temporary paralysis that resolve when the stressor is addressed.
That said, similar symptoms could also result from conditions like multiple sclerosis, early-stage Parkinson’s disease, or a vitamin B12 deficiency, which may not yet have been diagnosed. If a physical cause is discovered, the symptoms would no longer fall under the psychosomatic category.
5. Chest Pain Without Cardiac Cause
- What happens? Anxiety or stress can lead to chest pain due to muscle tension, hyperventilation, or heightened awareness of normal bodily sensations, even when the heart is healthy.
- Example: A person under intense emotional stress might rush to the ER with chest pain, only to find that their heart tests are normal.
However, chest pain could also stem from gastroesophageal reflux disease (GERD), costochondritis (inflammation of the rib cartilage), or other physical conditions. In these instances, the chest pain would not be classified as psychosomatic, even if anxiety plays a role in worsening the symptoms.
The Spectrum of Symptoms: A Clinical Challenge
Psychosomatic disorders often present as symptoms that mimic diseases, creating a diagnosis challenge when you visit the doctor. You may experience chest pain (but not have coronary artery disease), or joint pain (in the absence of arthritis). You may have symptoms of chronic fatigue that doesn’t align with measurable lab results like iron deficiency or hypothyroidism.
Another example is irritable bowel syndrome (IBS) – this is a fairly classic psychosomatic condition where gut-brain axis dysfunction plays a significant role, and stress can exacerbate symptoms like diarrhea or cramping. Read my article on the GUT BRAIN superhighway, and how you can improve the situation with serotonin.
Medications like amitriptyline (Elavil®), a tricyclic antidepressant, are often used at low doses for IBS, not to treat depression but to modulate pain signaling pathways and restore gut motility. You can learn more about that medication on WebMD.
The Role of Stress: The Silent Saboteur
Stress is a powerful driver of psychosomatic symptoms. When the body is in “fight or flight” mode for extended periods, the sympathetic nervous system dominates, suppressing digestion, sleep, and immune function. This can lead to disorders like tension headaches, hypertension, and even bruxism (teeth grinding). Caregivers of loved ones often live in “fight or flight” – a micro sympathetic overdrive- never knowing when the next health crisis with their loved one will occur. It’s a depleting way to be, but nevertheless, the chronic stress may cause your body to become ‘inflamed.’
That’s because chronic stress is almost always associated with increased markers of inflammation, such as C-reactive protein (CRP) as just one example. Over time, this state may worsen conditions if you have them like fibromyalgia… or may exacerbate autoimmune diseases such as lupus or Hashimoto’s thyroiditis. People experiencing these symptoms often benefit from stress-reduction practices (as opposed to high-impact aerobics which increase sympathetic overdrive) alongside appropriate medical therapy if needed.
What About Kids? They Have a Shadow of Early Adversity
Adverse childhood experiences, such as physical or sexual abuse, difficult divorces, parental alienation syndrome, or outright neglect, can leave a biological imprint on their little brain and body. These experiences dysregulate the autonomic nervous system, making these kids more prone to developing chronic conditions like chronic fatigue syndrome or somatic symptom disorders.
Adults with this kind of background who have unresolved trauma often display heightened activity in the amygdala (the brain’s fear center), which can perpetuate cycles of pain and stress. Treatments vary, some adults work through their issues all on their own as they age, while others require psychotherapy. There are pharmacological options for the depressed such as sertraline (Zoloft) and other SSRIs, which may help modulate the heightened stress response and reduce sensations of pain. I’m not a believer in these types of drugs as a first-line treatment at the get-go, just only if nothing else helps.
The Placebo Effect: Proof of the Mind’s Power
The placebo effect is often dismissed as anecdotal, but it’s a testament to the mind’s ability to influence physical health. In clinical studies, even patients with conditions like Parkinson’s disease have shown measurable improvement in motor function after receiving placebos. This underscores how belief and expectation can alter the brain’s chemical environment, boosting dopamine or reducing pain perception.
Research on the placebo effect has shown that the perceived “intensity” or “seriousness” of the treatment can influence how effective the placebo seems to the patient. The more painful the placebo, the more likely a person finds that it works. So an injection requiring a needle stick is more likely to produce a positive placebo effect than a pill that gets swallowed.
Harnessing this power in clinical settings involves reinforcing optimism and trust in treatment plans. For example, combining a trusted medication like naproxen or ibuprofen for joint pain with supportive therapies like gentle yoga or acupuncture can enhance outcomes by leveraging the body’s intrinsic ability to heal.
Managing psychosomatic disorders requires a dual approach that addresses both the physical and psychological components. Cognitive-behavioral therapy is one intervention for conditions like somatic symptom disorder or IBS, teaching patients to reframe negative thought patterns that perpetuate symptoms.
Medications like pregabalin (Lyrica) can help with neuropathic pain, while mindfulness-based stress reduction (MBSR) techniques like meditation have shown promise in reducing both anxiety and inflammation markers. Exercise, particularly yoga and tai chi which improve parasympathetic (calming) aspects of healing, can help reset the stress response, improve circulation, and enhance the mind-body connection.
Stigma: The Invisible Barrier
One of the biggest hurdles people with psychosomatic disorders face is stigma. These conditions are often misunderstood as “imaginary” or “attention-seeking,” which couldn’t be further from the truth. This misunderstanding can leave people feeling isolated and unheard, compounding their pain.
It’s important to emphasize that conditions like chronic pain, migraines, or functional neurological disorders are not “made up.” The symptoms are real and often rooted in complex physiological processes, even if they’re influenced by emotional or mental stressors. Just because you can’t see someone’s pain doesn’t mean it doesn’t exist or isn’t valid.
For those who are skeptical, consider this: the brain and body are deeply connected, and emotional stress can absolutely trigger real physical symptoms. Labeling someone as “mentally ill” or dismissing their experience simply because the cause isn’t visible or fully understood does a disservice to their suffering – and to the progress of medical science.
Recognizing these conditions for what they are—legitimate and complex—is the first step in fostering empathy and offering appropriate care. Let’s talk about care and medications for a moment, that’s next.
Medications to Address Underlying Psychological Factors
There are medications that can help manage (not cure) psychosomatic disorders, though the choice of medication depends on the specific symptoms and underlying issues. As a pharmacist, medications come with a diverse array of unwanted and uncomfortable side effects, so use them as a last resort. Also, keep in mind, psychosomatic disorders don’t have a one-size-fits-all treatment plan because they involve both the mind and body. Here’s an overview of medications commonly used:
Since psychosomatic symptoms often stem from stress, anxiety, or depression, medications that target these conditions are sometimes prescribed.
1. Medications for Psychosomatic Disorders
- Antidepressants:
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft®) or escitalopram (Lexapro®) are often used to manage anxiety or depression that might trigger or worsen physical symptoms.
- Tricyclic antidepressants (TCAs) in low doses such as amitriptyline (Elavil®) or nortriptyline (Pamelor® and Aventyl®) can help with pain syndromes like chronic pain, tension headaches, or IBS.
- Anxiolytics:
- Buspirone (BuSpar®) for chronic anxiety that might be causing symptoms like chest tightness or digestive upset.
- Benzodiazepines (ie lorazepam (Ativan®) or alprazolam (Xanax®)) for short-term anxiety relief, though these are not ideal for long-term use due to risks of dependency.
- Antipsychotic Drugs:
- Low-dose quetiapine (Seroquel®) or aripiprazole (Abilify®) may be considered under a specialist’s guidance. This is used for the most severe psychosomatic symptoms and manifestations of the disorder. Things such unexplained tremors or paralysis, psychogenic seizures, OCD, intrusive thoughts, muscle spasms (dystonia), unstable gait or dragging a leg, sudden loss of voice (called functional aphonia) or slurred speech without ANY physical or chemical abnormalities after being completely worked up. Sometimes these symptoms become inexplicable and termed “idiopathic.” In the case of these serious life-altering symptoms (and without any explanation), a doctor may prescribe a powerful medication such as an antipsychotic drug. These drugs are not considered the first treatment to use, but rather the last resort.
2. Medications for Symptom Relief
These drugs don’t address the root cause but can ease physical symptoms caused by psychosomatic disorders:
- Pain relievers:
- Over-the-counter options like ibuprofen (Advil®) or acetaminophen (Tylenol) for mild pain. Read this, Which is Better: Advil or Tylenol?
- Gabapentin (Neurontin®) or pregabalin (Lyrica®) for nerve pain related to conditions like fibromyalgia. By the way, if you take gabapenin for anything, you need to RESTORE 5 NUTRIENTS that have been depleted.
- Gastrointestinal medications:
- Antispasmodics like dicyclomine (Bentyl®) for IBS-related cramping.
- Proton pump inhibitors (PPIs) like omeprazole (Prilosec®) for stress-related acid reflux. H2 Antagonists like famotidine (Pepcid®) also work temporarily.
- Beta-blockers:
- Medications like propranolol (Inderal®) can reduce the physical effects of anxiety, such as a racing heart or tremors, and are sometimes used for migraines.
3. Medications to Enhance Sleep and Relaxation
Sleep disturbances are common in psychosomatic disorders, and improving sleep often helps alleviate symptoms:
- Sleep aids:
- Trazodone, which is technically an antidepressant, is commonly used at low doses to help with sleep.
- Melatonin or over-the-counter sleep aids may also be effective for some. May I recommend my own Sleep Script Tranquility Caps for a restful night, fall asleep faster, stay asleep longer.* Use this formula when you need/want, there’s no need to take it every day since it is a drug-free, non-addictive herbal formula.
- Muscle relaxants:
- Cyclobenzaprine (Flexeril®) for tension headaches or muscle pain caused by stress.
Psychosomatic Disorders in Summary
If you’re experiencing symptoms that don’t fit neatly into a diagnosis—or you’ve been told your condition is “all in your head,” know this: your experience is real, and your journey to healing is valid. Psychosomatic disorders remind us that the mind and body are deeply interconnected, and addressing both is essential to true recovery.
Key Difference
- Psychosomatic disorders: The cause is understood to be the interaction between your mind (emotions, stress) and your body (physical symptoms). If you’re super stressed about a test, you get a headache or an upset stomach. Perhaps you get a panic attack at work because you missed a deadline or made a mistake
- Hard-to-diagnose conditions: A person sees multiple doctors over 10 years never experiencing a cure, but continuing to develop more and more definable, measurable symptoms that have no trigguer. The cause for the disease is unknown or complex, and not triggered by any specific event. The condition might involve things science (or a doctor) hasn’t figured out yet. This is why getting multiple opinions is critical to you getting well.
Disorders That Don’t Fit Neatly into a Diagnosis
Contrast the above with conditions where doctors can’t find a clear cause for your symptoms, even after lots of tests. This doesn’t mean the symptoms aren’t real! It also doesn’t mean you have a psychosomatic disorder. This is completely different and means:
- Science doesn’t fully understand the cause of some conditions yet. For example, an older friend of mine with multiple sclerosis (MS) wasn’t diagnosed right away. MS is a neurological condition that damages the protective covering of nerves (myelin). Unfortunately, her diagnosis was delayed for many years because the tools we now take for granted—like MRI imaging—weren’t widely available. MRI scans can detect lesions or plaques in the brain and spinal cord caused by MS, which are key to confirming the diagnosis.
Before her diagnosis, many people (sadly) dismissed her symptoms as exaggerations or labeled her a hypochondriac. This highlights the challenges faced by people with undiagnosed conditions—just because science hasn’t yet caught up doesn’t mean their suffering isn’t real. Her story is a reminder to approach unexplained symptoms with empathy and an open mind, as medical knowledge continues to evolve.
- The problem might involve a few different systems in the body, making it hard to pin down.
- Doctors often rely on the tools and expertise within their own specialty, which can sometimes limit the scope of their diagnosis. For example, if you see a Lyme disease specialist, they might diagnose you with Lyme, even if your test results are inconclusive or borderline. Similarly, a mold expert is likely to attribute your symptoms to mold exposure, and a doctor with extensive experience in pharmacology might suggest you’re experiencing side effects from a medication. A rheumatologist, on the other hand, might diagnose a condition like fibromyalgia (a diagnosis of exclusion), or pin you with an autoimmune disorder, even if your lab values are not definitively abnormal in any way.
This isn’t to suggest that doctors are wrong or unhelpful—most are doing their best with the information they have. However, patients sometimes withhold symptoms out of embarrassment, making it harder for physicians to make an accurate diagnosis. Additionally, people may hesitate to seek a second opinion because they’re loyal to a doctor they trust and admire. While understandable, it’s crucial for patients to recognize that their condition might extend beyond a single doctor’s expertise, particularly if the doctor specializes in a specific field. Being open to additional perspectives can be essential for comprehensive care.
Final Thoughts
Living with psychosomatic or hard-to-diagnose illnesses can feel like an endless maze of questions, appointments, and tests without clear answers. It’s exhausting, and at times, you might even feel dismissed. Let me remind you: Your symptoms are real, and your journey matters.
Sometimes the issue lies in the intricate connection between your mind and body; other times, it’s simply that science hasn’t caught up yet to explain what’s happening. Either way, the key to healing starts with being heard, believed, and supported.
As a pharmacist, I’ve seen how blending medical care with compassion and curiosity can make all the difference. Don’t be afraid to ask questions, seek second opinions, or explore treatments that nurture both your body and mind. You are your own best advocate, and healing isn’t always linear, but it’s possible.
Stay strong, stay curious, and never stop fighting for the care and understanding you deserve. You’ve got this!
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.
