There are countless people suffering everyday with symptoms that are medically unexplained. They may have a label/diagnosis but insufficient explanation as to what is actually going on to fully manage it. These are often managed with medication such as painkillers or anti-inflammatories, or patients simply have to try and put up with them having received a half-hearted explanation from their primary care physician. Examples include non-cardiac chest pain, tension-type headaches, globus-syndrome, chronic fatigue syndrome, non-epileptic seizures, candidiasis hypersensitivity, chronic pain syndromes, irritable bowel syndrome.
When a patient goes to their primary care physician for a physical symptom they should, of course by investigated to see if the symptom is caused by a physical health problem. For example, if you have difficulty swallowing, the physician will first take a full history, then your throat will be examined and further tests/scans etc will be done to discover any pathophysiology . Differential diagnoses could be gastro-oesophageal reflux disease (GORD), stroke, multiple sclerosis and various cancers. But if all of these are ruled out by the time the various tests are finished the most important thing is not to dismiss the patient’s symptom! How many of us with chronic symptoms have had various tests come back as “all clear” and thought—so what next?! I’m still suffering…how do I manage my symptom(s)?!
Research has shown that 52% of adult referrals to rheumatology, cardiology, gastroenterology, neurology and gynaecology have no known pathology linked to that speciality and are therefore discharged from that speciality without a management plan. This happened to me when I was referred to rheumatology—I received a half-hearted diagnosis of fibromyalgia, was told there might be a leaflet in the waiting room I could pick up on my way out and that was that. No treatment options, no plan, no hope.
It can be very difficult to see how a very physical symptoms can have any psychological component but the mind is an incredibly powerful organ. It controls everything that happens in your body. Day-in-day-out, unconsciously, your mind controls digestion, metabolism, your heart rate and respiration. You don’t consciously think “breath-in…breath-out…” but your body just does it. However, you can choose to slow down or speed up your breathing, take a deep breath or hold your breath if you want to. It’s also been shown that being aware of your heart beat can be effective during times of anxiety when you need to calm yourself down, you can consciously slow it down.
If you want to manage physical symptoms, a helpful exercise can be to think about where you feel emotions. For example, most people feel, at least a little workplace stress—where do you feel this? Do your shoulders feel tense? Does your chest feel heavy? Do you feel a knot in your abdomen? Noticing how your emotions impact your body is an important start on the road to getting your mind and body re-connected.
Another helpful processes is to think about when you first started noticing your physical symptoms. For example, did you experience a bereavement, a period of work stress, bullying, car accident or other trauma? Once identified, considering how you managed this event is key—do you think you’ve fully processed it? Don’t compare yourself to others, everyone deals with life’s events differently. Do you think there’s a pattern to how you deal with things? Are you a stiff-upper-lip type? Or do you busy yourself with helping others? Perhaps some things feel too painful to process? Noticing these patterns and considering what impact this could be having is important. If we don’t process stressful events, the stress needs to go somewhere; the tissues in your body will hold onto it until your consciously choose to release it.
Not processing events fully can lead to shame and guilt. Holding onto these feelings becomes a negative cycle that can impact every area of life.
You may feel that your physical symptoms come and go randomly with no connection to anything and despite trying to find triggers. The body is amazing at holding onto stress and releasing it at a later date. For other people the body provides an early warning signal that your under stress. Counselling can help you become more aware of your emotions and how you process them. It can also help you becomes more in tune with your body, which, in turn, will improve your physical health.
If you’re not yet convinced that the brain-body connection is important, take a look at this study (Suzanne C. Segerstrom, Ph.D., et al.), it shows that law students who were confident had more and better functioning immune cells than worried students. This systemic review and meta-analysis (Alan Rozanski, MD, et al.) also showed that optimism was associated with lower risk of cardiovascular events.
During these difficult times, people are struggling with all sorts of unusual experiences and are dealing with untold pressures, don’t downplay how hard you’re finding it! It’s been shown that talking is one of the most important things we can do, whether this is to a trusted friend or to a professional counsellor, making the first step will be the hardest but it will benefit every aspect of your life.