All in My Head?

I have met with plenty of people who come to see me for therapy, unsure if there is a medical problem or an emotional one causing their body to feel unwell. Often, they tell their doctor about what they are experiencing, and if a medical cause isn’t easily seen, they are told to seek out therapy, assuming that the cause is an emotional one. For therapists, we are told to not diagnose someone with a mental health condition until medical causes are completely ruled out. Unfortunately, that leaves people in a predicament, where neither therapist nor doctor can properly diagnose them. So how can we assess the cause further?

For me, there are a few signs I look for something having an emotional cause, and Jon Frederickson says it well in Co-Creating Change: Effective Dynamic Therapy Techniques, “If somatic symptoms rise and fall when feelings rise and fall, the symptoms are psychosomatic. They are caused by anxiety or the defense of somatization. If the symptoms do not shift in response to anxiety and feeling, psychological causes do not play a role in symptom creation.” Meaning, if we purposefully bring up something emotionally stressful and the physical sensation doesn’t also increase, or show up when we do that, I might be wondering about medical causes. Now you can’t really do that assessment the opposite way around, where if you are not stressed, but feel the physical discomfort arise, then that means that the problem isn’t mental health, as many people are unaware of their emotions, and may be ignore an emotional problem that exists.

There is also the back-and-forth relationship many pain conditions or chronic health issues have with emotions, where the pain and inflammation make most people moody and depressed, and many people with these medical diagnoses notice that their physical symptoms get worse when they are stressed. Often, I find it helpful to try to treat both possible causes at the same time. So even if there is a medical problem, I find addressing emotions to be helpful in reducing physical discomfort anyways, and caring for medical health tends to help one deal with any emotional causes as well.

“If somatic symptoms rise and fall when feelings rise and fall, the symptoms are psychosomatic. They are caused by anxiety or the defense of somatization. If the symptoms do not shift in response to anxiety and feeling, psychological causes do not play a role in symptom creation.”

~ Co-Creating Change: Effective Dynamic Therapy Techniques, by Jon Frederickson