Stress, Depression and Psychosomatic Illness

Stressed man with headache at desk
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The term psychosomatic refers to real physical symptoms that arise from the mind and are influenced by emotions rather than a specific organic cause in the body (such as an injury or infection). 

A psychosomatic illness originates from emotional stress and manifests in the body as physical pain and other symptoms. Depression can contribute to psychosomatic illness, especially when the body’s immune system has been weakened by severe and/or chronic stress. 

A common misconception is that psychosomatic conditions are imaginary or "all in the head.” In reality, physical symptoms of psychosomatic conditions are real and need treatment just as any other illness would. 

Unfortunately, this does not always happen in a timely or effective manner. The pervasive social stigma attached to psychosomatic illness may prevent someone from seeking treatment. 

Even when someone does seek treatment, stigma is also present in research and medical communities, at least in part because the mechanisms that drive the stress-illness relationship are not yet fully understood. 

Symptoms

You may not have thought much about the unique ways stress manifests physically, but it can be helpful to learn how to recognize when you are under extreme stress. Once you identify the signs, you can work on reducing the effect stress has on your health

While it sounds like a complicated undertaking, there are actually some simple ways you can determine if you are stressed out

Try this exercise: take both your hands and touch your neck. If your hands feel significantly colder than your neck, it is a sign you are under stress. If they are warm, you are relaxed. 

Other common physical signs of stress include:

  • Racing heart
  • Sweaty palms
  • Tense muscles
  • “Butterflies” in the stomach

Bodily signs of stress may be different depending on if you are biologically male or female.

For example, women often report symptoms such as fatigue despite getting enough sleep, irritability, abdominal bloating, and changes to their menstrual periods.

Signs and symptoms of stress in men are more likely to include chest pain, increased blood pressure, and changes in sex drive. 

Symptoms of stress also vary by age. Children often display stress through their body because they haven’t yet developed the language they need to communicate how they feel. For example, a child who is having a hard time at school may have frequent stomach aches and may be sent home or ask to stay home. 

Stress in the teen years can be especially intense, particularly during periods of major social adjustment and hormonal shifts. Sometimes, signs of stress in people in this age group may be missed or attributed to “teen angst” when it is really a sign of adolescent depression

The elderly are also prone to depression, as they are often contending with several compounding factors, such as isolation, loss and grief, and chronic or serious health problems. If you are caring for an aging loved one, make sure you know the signs of depression in older adults

Causes

There are actually different kinds of stress, some of which can be positive. Eustress is what makes life invigorating and interesting. It's a feeling that makes you want to get up in the morning and keeps you motivated.

If you've ever enjoyed the thrill of a roller coaster ride or felt a sense of excitement and fulfillment when completing a project, you've experienced "good" stress.

On the other hand, if you've ever experienced a major loss, gone through a big life change, or endured other stressors, you also know what "bad" stress feels like.

Just like you can feel the giddiness and uplifting feelings of good stress all over, the negative effects of bad stress can be felt in your mind and your body.

While the exact mechanisms are not completely understood, researchers know that stress and depression can be expressed as physical pain and illness. It’s a complex process, but here’s an analogy that might help.

Compare your body to a pressure cooker. If it's allowed to vent its steam, it works efficiently. If it can’t vent steam, the pressure continues to build until the lid blows off. 

Now, imagine that the cooker is under pressure already and you apply more pressure to keep the lid on. When the container can no longer hold in all the pressure, it will break at its weakest point.

Like the pressure cooker giving way at the weakest point of its structure, stress-related illness is most likely to develop where your body is already weakened. 

Someone who is under stress and not able to “vent” their emotions or who tries to “keep it all in” will eventually reach an emotional breaking point. It may manifest as a bout of situational depression or trigger an episode of major depression.

In retrospect, you may realize there were some warning signs or "clues" that such a break was coming—especially in terms of the physical symptoms you experience.

For example, if your neck has always been your physical weakness, you may find your pain increases when you are stressed. Back pain, stomach trouble, and headaches are other common ways stress may take up residence in your body. 

Stress can also compromise your immunity. Some people find that when they are stressed, they’re more likely to catch a cold or the flu. They may also get more infections or take longer to get better. 

One way researchers think stress causes physical symptoms and illness is through the release of certain chemicals in the body, including cortisol and adrenaline, which can lead to inflammation

These chemicals are an important part of the body’s “fight or flight” response to stress and can be very useful. However, if the body has high amounts or they are released continuously over an extended period of time, these chemicals may do more harm than good

Diagnosis

When you go to your doctor with physical symptoms, they will generally look first for a physical explanation for your pain. If there is no obvious physical cause that they can easily test for, coming up with a diagnosis and plan of treatment may be tricky. 

When this happens, people might feel like their doctor is not taking their symptoms seriously, thinks the person is making it up, or that it's "all in their head."

When your doctor can’t find a clear physical cause for your pain (such as an injury or an infection) they may ask you about how you feel emotionally. The hope is that if a source of stress can be identified, it can be treated (just as you would get treated for an injury or illness).

When they ask about stress in your life, a doctor doesn’t mean to imply that your pain is not real. Symptoms caused by stress that you feel in your body are very real, they are just caused by a different mechanism that, say, if you broke a bone. 

Treatment

Your doctor may want you to talk to a mental health professional, but that’s not to say that your physical symptoms only need psychological treatment. It is important to learn how to effectively manage stress, but that is often a process and can take time. In the meantime, you need to treat your physical pain and other symptoms.

For example, if you have pain in your neck, learning to cope with stressful triggers can certainly help prevent from happening—but the pain is not only in your mind.

While it might start in your brain, stress can cause a cascade of chemicals in your body that produces inflammation in the muscles of your neck, which in turn causes you pain. You may need anti-inflammatory medications or another type of treatment, such as massage and physical therapy to manage your pain.

Another helpful analogy is to think of psychosomatic illness as a flooded river that happens after a dam breaks. The most important step for preventing more flooding is to fix the damn. However, it’s also necessary to handle the flooding that’s already happened while the dam is being repaired. 

Coping

Once you know how to recognize when you are stressed and have identified sources of stress in your life, the next step is to learn coping mechanisms. One of the first (and most important) is to avoid holding in your feelings. 

Like a pressure cooker, stress that is pent up in your body will come out one way or another. The healthiest thing you can do is to develop a controlled way to “vent” instead of letting stress find a weak point and explode. 

As you’re working on developing coping mechanisms for combating stress, check to see if you have been using any unhealthy coping mechanisms, such as overusing alcohol.

There are innumerable methods for healthy coping, it’s just a matter of finding what works best for you. Here are a few ideas to get you started. 

  • Confide in a friend.
  • Join a support group.
  • Learn relaxation techniques.
  • Be honest with others (and yourself).
  • Make time for leisure activities you enjoy.
  • Explore fun new ways to deal with stress.
  • Take a break if you're in a stressful situation.
  • Eat a balanced diet, get regular exercise, and create a calming sleep space.
  • Let go of grudges, patterns of thinking, or relationships that are not healthy or helpful for you.
  • Do something nice for someone else (and be sure to do nice things for yourself, too!)
  • Try herbal supplements for stress or stress-fighting herbal tea (note: these products can have side effects just like prescription medications, so talk to your doctor to ensure it's safe for you to take them).

Remember that everyone handles stress in their own way. Two people in the same stressful situation will react very differently. Once you understand the unique way stress affects you (both emotionally and physically) you can work on developing healthy and effective ways to manage it.

A Word From Verywell

One final thought about learning to deal with the physical effects of stress, as well as understanding psychosomatic illness, is your willingness to let go of what isn’t working for you. The first step is accepting that you are human and allowing yourself to be human. Then, you must be willing to do some work which may be difficult, such as allowing yourself to feel some emotions which may be hard for you to confront. You may need to let go of expectations and old guilt—the “shoulds” that have been guiding your behavior. You may need to give up control in some areas of your life or ease off your tendency to strive for perfection. Remind yourself that it’s OK to fall short of your goals as long as you are trying and doing your best. As you are identifying stress in your life, you may realize a big source is the pressure you put on yourself. 

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