By: Dr. M. Aleem Siddiqui, MD, DPM ( Associate Editor-ICN Group )
LUCKNOW: We all have physical symptoms – painful or uncomfortable feelings in the body – at different times in our lives. Usually a physical cause can be found – but sometimes it can’t, even when blood tests and x-rays or scans have been done.
Symptoms like this are common. They can be called “medically unexplained symptoms”.
About 1 in 4 people who see their doctors have such symptoms.
Medically unexplained symptoms are really frustrating because ……
• The tests for your symptoms are all normal – but you still have your symptoms.
• An important part of getting better is understanding what the problem is – and neither you nor your doctor know.
• It can feel as though other people think that your problems are imaginary, or that you are making them up.
*What sort of symptoms can be medically unexplained?*
The commonest ones include:
• pains in the muscles or joints
• back pain
• headaches
• tiredness
• feeling faint
• chest pain
• heart palpitations
• stomach problems – pain, feeling bloated, diarrhoea and constipation, gas in body parts
• collapsing, fits, breathlessness, weakness, paralysis, numbness and tingling.
*What causes medically unexplained symptoms?*
Medically unexplained symptoms aren’t “all in the mind”, but neither are they all in the body. To understand them we have to think about how the mind and the body work together.
How are the mind and body linked?
We often think of our minds and bodies as two separate things. In fact, they work together and affect each other.
Research shows that there is two way communication between our brains and bodies. This happens because:
• Signals travel down the nerves from the brain to the body … and back again from the body to the brain.
• Natural chemicals, called ‘hormones’, circulate in the bloodstream. Some are produced by the brain and affect the body ….. and some are made in the body and affect the brain and the way we feel.
Every day, thoughts, feelings and stresses play a part in making changes in our bodies – for example:
• when we feel embarrassed, we blush
• feeling worried or frightened can cause an uncomfortable feeling of “butterflies in the stomach”
• when we get upset we feel our throat tighten – “a lump in the throat”.
We also know that the way we think and feel can make us physically ill. For example:
• feeling low or stressed makes any pain we have feel worse
• long-term stress can make us more likely to have high blood pressure or a heart attack.
A disease in the body can affect the way we think and feel.
*Ways of thinking about the mind and the body*
There are different ways of thinking about how the mind and the body are linked that can help us to understand medically unexplained symptoms.
• Like a computer – hardware and software
You can think of the brain and nerves as like the computer that sits on a desk. But the electrical messages that run through the nervous system are like computer programmes or “software”.
Let’s look at what can happen when someone loses the use of an arm or a leg. It can be problem with the hardware. The brain or nerves can be damaged by a stroke or an injury, so the messages can’t get to or from the arms and legs. However, you can get the same symptoms without any damage to the brain and the nerves. There seems to be a software problem. The brain and the nerves are intact but, because the software is not running properly, they are not controlling the limbs properly.
These “software” problems can happen when you are under a lot of stress. Stress seems to interfere with messaging (or “software”) of the brain and nerves. A simple example is when someone collapses or faints when they are under stress, like a computer crash.
• Being “out of tune”
Another similar way of thinking about the cause of symptoms is like a car or piano being out of tune. All of the parts are there, but they aren’t working properly.
*How does feeling stressed cause physical symptoms?*
Over thousands of years, we have evolved a way of responding to stress that gets our body ready for physical action. This was useful when life was more dangerous. If a cave man was attacked by a tiger, it was important that they were able to fight the tiger or run away. This is sometimes called the “fight or flight response”.
We still have lots of stresses. Nowadays, though, we don’t need to physically react to most of these stresses. For example, we may feel under stress if we take an exam, give a talk to colleagues at work, or if we need to be somewhere in hurry and our bus is late. Our body’s stress response gets going and our body gets ready for physical action – but there is nowhere for the energy to go.
This kind of stress response can give you:
• rapid heartbeat and palpitations
• chest tightness and breathlessness
• dizziness, faintness and feeling light headed
• feeling strange or “spaced out”
• shakiness and tremor
• indigestion, feeling sick, diarrhoea
• dry mouth
• tightness in the throat
• numbness and tingling
• headache, muscle tension and neck stiffness
• sweating and feeling hot or cold.
These physical symptoms of stress can feel very uncomfortable, especially if we don’t know why they are happening. They can make us feel ill. This worry can cause even more stress and bodily symptoms, making us feel even worse … and so on. This is more likely to happen if stress goes on for a long time, as when we have money or job worries, or relationship problems.
*How can being ill with anxiety or depression cause bodily symptoms?*
Anxiety or depression obviously affect our mood, but they can also cause physical symptoms. We may recognise the physical symptoms, but find it harder to see that we are anxious or depressed. So we tend to think that these symptoms are due to a physical cause – when there is none.
Most people who go to their GP with anxiety or depression begin by talking about bodily symptoms.
Is there a diagnosis for these symptoms?*
We can give a name or a “diagnosis” for symptoms when:
• they occur together in a particular pattern in many people, or
• when they share a similar cause.
Diagnoses for certain patterns of medically unexplained symptoms include:
*• Irritable bowel syndrome* – troubling stomach symptoms
*• Fibromyalgia* – widespread bodily pain and tenderness
*• Non-epileptic attack disorder* – in epilepsy, fits are caused by problems with the electrical activity of the brain.
In non-epileptic attack disorder, someone has fits that look like epileptic fits, but the electrical activity of the brain is normal.
Examples of diagnoses that may be made because of possible causes of these symptoms include:
*• Somatisation disorder and somatoform disorder* – where stress is thought to be a major cause of the symptoms, especially when the symptoms go on for a long time or are particularly severe.
*•Dissociative disorder* (also called ‘conversion disorder’ or ‘dissociative-conversion disorder’) – where it is thought that symptoms that look like they are caused by a disease of the nervous system (e.g. fits, paralysis, loss of memory), but are in fact caused by stress.
*• Health anxiety* (sometimes called hypochondriasis) – where someone worries a lot that their symptoms mean they have a serious physical illness, despite reassurance that they are not physically ill.
*• Body dysmorphic disorder*– where someone is overly concerned about an aspect of their appearance, which causes them considerable distress or gets in the way of everyday life.
Other diagnoses can be given for medically unexplained symptoms, but it is common to use a general term to describe the symptoms, such as “medically unexplained symptoms”.
*What can be done to help?*
Tackle other stresses
Make your life healthier
Take regular exercise
Find time to relax
Stop looking for reassurance and information about your symptoms
Antidepressant medications
Cognitive behavioural therapy (CBT)
Psychodynamic therapy
Problem-solving therapy and solution-focussed therapy
