Psychosomatic pain – what your body is telling you

Have you ever experienced stomach aches before going to an important job interview, back pain when working on that impending deadline, or tension headaches when feeling overwhelmed? Chances are you have been experiencing physical pain caused in part by a stressful situation.

This post is the first in a series that will help you reduce this type of pain–called “psychosomatic pain” because it involves both mind (“psyche”) and body (“soma”). 

Psychosomatic pain is real, and it negatively affects nearly everyone at some point. In some cases, emotions can bring about symptoms in the motor and sensory systems–like insomnia, weakness, and migraines–without producing any measurable physiological changes in the body. Other times, psychosomatic pain leads to measurable physiological changes, such as ulcers, irritable bowel syndrome, and muscle spasms. Psychosomatic pain may cause chronic health problems affecting your wellbeing and productivity. 

Specifically, we will give you:

• Tools that will help you become more aware of triggers that may cause you to experience psychosomatic pain
• Strategies that will help you reduce psychosomatic pain
• Guidelines on how you can implement common pain reduction treatments in your daily routine

To start off, this post will give you a deeper understanding of psychosomatic pain, and how stress, when left unattended, can lead to multiple physical issues.

Specifically we will take a close look at:

• How pain is our body’s way of telling us something is wrong
• Steps to identify what your pain is telling you and how to respond, and
• How awareness of the causes of stress can help prevent future psychosomatic pain

This post is based on over 30 papers on psychosomatic disorders, stress, emotional awareness, and chronic pain, pulled from Psychology and Medicine.

Pain: your body’s way of grabbing your attention

To understand psychosomatic pain, it helps to first understand why we feel any pain. Pain is usually useful – it grabs our attention, telling us something is wrong so maybe we should do something about it. Pain tells you to pull your hand back from the stove burner, rest after breaking your ankle, or not eat those poisonous berries ever again.

The problem with psychosomatic pain is that sometimes it isn’t clear what your pain is telling you.  For example, a tension headache doesn’t indicate that something is physically attacking your forehead but rather that you might be feeling stressed, overwhelmed, or tired.

Even more confusing, psychosomatic pain might actually be distracting you from the real underlying issue: chronic stress, past trauma, or uncomfortable emotions. 

An early hypothesis actually suggested that psychosomatic pain occurs when people try to avoid psychological pain by “converting” it into physical pain.

More recent hypotheses suggest that psychosomatic pain begins with physical injuries, but physical pain lingers or is felt more intensely because people use the physical pain to avoid psychological conflict.

 

Responding to your psychosomatic pain

So next time you’re feeling pain, how do you determine what it is telling you?  We’ll next turn to some simple steps to figure it out.

 

Step 1: Check for a physical component

It is of course important to rule out any physical reasons for your pain. Even some illnesses that have psychological roots may have physiological components–like ulcers or migraines–that can be partly alleviated with traditional medicine. 

 

Step 2: Check for emotions and life stressors

If there is no clear physical reason for your pain (or if your pain continues despite medical treatment), consider whether life stressors or negative emotions might be involved. The first step in reducing and preventing psychosomatic pain lies in becoming aware of your negative emotions, and the triggers that lead to them.

Consider whether you’re feeling any emotions–and label them. To quickly recap, an emotion is:

• An intense and short-lived feeling,
• Caused by an evaluation of an (real or imagined) event that is important,
• Preparing the body to react or pay attention to the events

Psychosomatic symptoms occur when emotional eruption is imminent, so our goal will be to defuse negative emotions before they can form. Luckily we’ve already written an extensive module on emotion regulation that may help you become more aware of your emotions, and give you tools to deal with emotions in a positive manner. 

The first step consists of recognizing these negative emotions, and putting them to words. This is extremely important, as a study found that 59% of adolescents who experience persistent somatoform (i.e. psychosomatic) pain have a higher level of alexithymia, or a difficulty of putting words to feelings, in comparison to healthy adolescents.

Detecting signs of emotions early on gives you a chance to help prevent the negative emotions from forming and reduce their damage. So take a moment and ask yourself:

• What am I feeling? Pounding heart, pit in my stomach, tense muscles?
• How would I label the emotion(s) that are coming on?  Anger, fear, anxiety, sadness, envy, frustration, something else?
  

Think about stressful standards or events in your life. Modern workers face a myriad of stressors. Stress and negative emotions go hand in hand, as higher levels of stress seem to be predictive of increased negative emotions such as frustration, anger, and anxiety. 

It is no surprise that stressful events are known to precede substantial aggravation of lower back pain in patients with lower back pain without a clear organic cause (i.e. psychosomatic), and that people with stressful jobs. Police officers, for instance, report psychosomatic symptoms (e.g. headaches, indigestion, stomach aches) and conditions (e.g. high blood pressure, ulcers, colitis) at a greater frequency than the average general population.

It is not only our job that can lead to stress. The biggest source, most often, is ourselves. This self-imposed stress comes from certain goals and milestones that we set for ourselves such as graduating college before you turn 22, having kids before you’re 35, or being wealthy by 50.

Even small(er) goals such as finishing a project before the end of the day or reading a book before the end of next week, can (needlessly) put us under a serious amount of pressure.

So begin by setting aside a minute to think about what might be adding stress to your life.  Common examples include:

self-imposed internal pressures to conform to ideals such as

• Be the perfect employee
• Be the perfect spouse
• Reach certain milestones (e.g. owning a home by 30, a family with two kids by 40, a successful business by 50)

external pressures such as

• Financial (in)security
• Job (in)security 
• Health issues
• Family-related pressure (e.g. marital problems, care of children/parents)
• Developmental pressure (e.g. aging, facing death) 

or memories of previous stressful events such as

• Relationship problems with family members or romantic partners in the past
• Frightening or sad experiences as a child
• Feelings of anger, frustration, or guilt that never fully went away.

 

Step 3: Decipher which part of the stressor is external, and which part is internal

Life stressors are typically a tangled mess of external and internal influences. Very seldom will you encounter a life stressor that is solely external, or solely internal. Take for instance workplace stress. A large part may be because of high work-pressure, difficult colleagues, or a difficult boss, but a significant part can also be due to your own expectations of how you ought to be performing, or where you ought to be in your career in comparison to your peers.

It is important to have a clear distinction, as external stressors are tackled differently than internal stressors.

 

Step 4: Tackle your external stressors

External stressors come in a wide variety of forms. Whether it is your boss expecting to have the report in by the end of the week, or having financial stress because you have bills to pay, the common denominator is that they are expectations of something that you have to meet up to.

While it is difficult to have a clear cut approach for all external stressors, there are some tips on how to reduce their pressure.

Engage in clear communication on the feasibility of the expectation. While it may be difficult to own up to not being able to deliver what is expected, clearly communicating it to the source (e.g. boss, or colleague) will update the expectation, meaning that more attainable expectations can be made. Urgency is key, as the quicker you are to change the expectation, the more time is left to come to an alternative solution.

Don’t be afraid to ask for help. While during times of stress and anxiety you may feel that you are all on your own, this usually is not the case. Stress can make us blind to the opportunities that are around us. Maybe you are stuck on a project, and you can’t find the solution, while your colleague has experience with these kinds of problems. Or you may even be lacking the means to meet up to the expectations, which may be the case of financial problems. 

You must not be afraid to ask for help. We have been brought up to be self-reliant and independent, and may feel like asking for help will harm the relationship that we have with the other person, but the opposite seem to be true. People tend to be kinder to people who they have helped, as our brain rationalizes the helping behavior as being only done for people we like. Asking for help actually seems to strengthen the relationship. So when you feel that you can’t live up to expectation, ask for help.

 

Step 5: Tackle your internal stressors

Internal stressors, in contrast to external stressors, originate from expectations that we impose on ourselves. While being affected by external sources such as peers, the main source of the stressors come from your own expectations of yourself. Strategies to tackle internal stressors, therefore, start by looking at you as a person.

Evaluate whether you are a “perfectionist”? Life stressors can be especially difficult for people who are “perfectionists”. Holding yourself to standards that are never quite attainable, and compulsively try to nevertheless attain those excessively high standards isn’t a healthy or an adaptive way to function (here’s a framework to battle your perfectionism by the way). Despite the praise you may receive from your employer or others, perfectionism usually tends to lead to a lack of satisfaction, tension, self-criticism, and time pressure (because there’s always more to do). 

Take this quick online test to see if that might be happening for you.

Get logical about self-imposed stress. If we want to tackle self-imposed stress, we first need to be able to differentiate between external pressure and self-imposed pressure. Not all pressure is without reason. Setting yourself the goal to finish a project by the end of the day because you need to turn it in to a customer is indeed a valid source of pressure, and should not be taken lightly. Setting yourself the goal to finish a project by the end of the day because you feel that you need to be the best employee in your department, on the other hand, does not warrant the same level of stress.

So the first step is to assess whether the pressure that you are feeling comes from an external source (e.g. boss, customer), or from a goal set by yourself.

Next it is time to make a list of the benefits that are connected to the goal. For instance, what do I gain from being the best performing employee of the department? 

1. I will get higher appraisal from my boss
2. Maybe more likely to be eligible for a promotion
3. …

Next, make a list from the consequences that are connected to the goal. For instance, what does it cost me to achieve this goal?

1. I work under a lot of pressure
2. I am lacking sleep due to stress
3. I have less time to put towards my social life
4. I am experiencing physical pain
5. …

Next it is time to weigh the pros and cons. Are the benefits worth the stress and the pressure that I put myself under? How much difference would it make if I wasn’t the best employee, but maybe third or fourth best? Would that lower my boss’ appraisal towards me? Would I therefore be exempt from any form of promotion?

More importantly, what do I gain from lowering my goal? Having less stress and pain will give me more energy to do my job better. Having more time to spend with friends and family will give me more satisfaction than striving for a distant goal.

It may be difficult if you are really perfectionistic, so a good last step will be to setting small attainable goals. Work in increments, and set greater goals, while constantly remaining vigilant of your well-being.

 

Recap of psychosomatic pain – what your body is telling

Psychosomatic pain is something everybody will come into contact with during their lifetime.

Taking your time to try to decipher the causes of your pain may greatly help you deal with your psychosomatic pain. Emotions play an important part. So the first step to tackling it can be to consider whether emotions or stress might be involved, and to label them.

Next, analyze your current situation by deciphering internal and external stressors. This will give you starting points to start reducing the cause of your negative emotions and stress, which in turn will reduce the occurrence of your psychosomatic pain.

Specifically, reduce external stressors by:

• Updating expectations by engaging in clear communication
• Not being afraid to ask for help

And internal stressors by:

• Becoming aware of your own perfectionism
• Getting logical about self-imposed stress.

Tackling stress is half the battle. Being able to detect signs of emotions early on, and engaging in emotion regulating behavior will help prevent the negative emotion from forming, or otherwise mitigate the damage they cause. 

For tips on becoming more proficient in recognizing and regulating negative emotions please have a look at our posts on emotional intelligence. For a more in-depth look at battling perfectionism please have a look at our posts on self-doubt.