Some people are preoccupied with their various physical symptoms, ones for which the doctors can find no cause. These people have gone to many health professionals and have been sent for numerous tests, but their symptoms remain as unexplained as before.
Perhaps you know such individuals. Or you are one of them.
The origins of some of these physical symptoms may be psychological. Many of us know, firsthand, how stress and anxiety contribute to physical problems―to headaches, backaches, muscle tension/pain, fatigue, digestive problems, sleep difficulties, etc.
Nevertheless, some of us resist the idea that psychological factors give rise to our symptoms, perhaps assuming that the notion of psychological causation is in some ways the equivalent of “it is all in your head,” “there is nothing wrong with you,” or “you are making it up.”
That is not how I see it. That the origins of some symptoms may be psychological does not make them any less real or significant than if they were physical symptoms.
The symptoms are real.
The suffering is real.
The main difference between physical symptoms associated with a physical disease or a psychological disorder would not be in what is real and what is fake, but in the choice of treatment and the diagnostic label.
What diagnostic label?
There is a category of psychological illnesses in DSM-5,¹ referred to as somatic symptom and related disorders. People with these disorders present with physical symptoms (such as pain), which do not appear to have a medical cause.
Let us consider some of the major disorders in this category, starting with somatic symptom disorder (SSD). The criteria for SSD are:
- The presence of at least one somatic symptom that is either distressing, or that significantly interferes with daily functioning.
- Excessive feelings, behaviors, and thoughts regarding somatic/health concerns, as shown by at least one of the following:“1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns.”¹
- At least some of these symptoms must have been present for six months or more.
Another major disorder in this category is referred to as illness anxiety disorder, an illness which is associated with the fear that one already has or may acquire a severe illness. The main difference between this disorder and SSD is that those with illness anxiety disorder have a limited number of somatic symptoms; furthermore, they are preoccupied not so much with their symptoms as with the possibility of having a disease.
Another condition, called conversion disorder, is related to altered motor or sensory function. Motor symptoms include the likes of abnormal posture, irregular movements, weakness, and paralysis. Sensory symptoms might include problems related to hearing, vision, and skin sensations.
I would like to emphasize that no matter how serious the symptoms associated with conversion disorder (like other disorders in this category), they have no medical cause. For instance, a person with conversion disorder may visit her doctor, complaining that she is no longer able to see, but tests will show that her eyes are healthy and that she should be able to see.
Lastly, factitious disorder is a condition associated with intentional fabrication of symptoms of an illness. The reason for falsification of symptoms is important in making the correct diagnosis. Specifically, individuals with factitious disorder are not motivated by any obvious rewards; if there is a clear motivation for the behavior (e.g., to avoid criminal responsibility, receive worker’s compensation, etc), then the behavior would be called malingering.
So why do people with factitious disorder fabricate symptoms? There may be subconscious psychological motivations typically related to playing the “sick role” (e.g., receiving attention and care).
As I conclude this article, I would like to suggest that if you identify with any of the above descriptions, it could be a good idea to read more about these disorders and maybe even see a mental health professional. Psychological and pharmacological options are available for treating the above disorders, and can help improve your symptoms and reduce your suffering.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.