It’s subtle and difficult to detect at first. The symptoms are identical to somatic illnesses. What sets it apart from physical illness is the source of the pain. In somatisation, the cause of the discomfort are psychological issues that need to be addressed. What else is typical for somatisation?

Somatisation refers to psychological processes in which unconscious emotions are expressed as physical pain or other medically unexplained somatic symptoms. The term "somatisation" is also used for patients who report physical symptoms associated with their emotional suffering.

Psychosomatic disorders can also affect patients who may not yet experience any physical symptoms but still fear somatic illness or believe they are already affected by it, and experiencing actual symptoms is only a matter of time.

The concept of somatisation can also apply to people who experience symptoms that lower their quality of life and lead them to seek medical help.

Somatisation - A Cry For Help

Somatisation in all its forms is a common occurrence in standard health care and psychiatry. It’s a functional disorder, which means that the patient genuinely experiences physical discomfort, their quality of life deteriorates, and subjective suffering occurs.

People who experience somatisation usually don’t suspect that their well-being may have a psychological basis. They typically turn to their GP and then to numerous specialists, depending on which part of their body is currently causing symptoms.

But further often costly tests don’t reveal any physical problems, even though the patient still feels unwell. That’s why knowledge of somatisation is crucial, as its absence can lead to a lengthy, fruitless search for the source of pain, which has a psychological root cause.

Somatisation in the Context of ISTDP Psychotherapy

The approach to somatisation according to Habib Davanloo (1989), who is considered as the creator and initiator of Intensive Short-Term Dynamic Psychotherapy (ISTDP), speeds up the therapeutic effects resulting from the collaboration between the patient and the therapist.

ISTDP is an excellent method for treating mental, emotional, and physical disorders because it focuses on experiencing emotions that reside in the body. While working on somatisation, Davanloo noticed significant similarities between the ego of somatising patients and depressed patients.

Both groups of patients had great difficulty accessing their own emotions, particularly anger, and when this emotion did arise, patients almost immediately denied or repressed it from their consciousness.

In response to this discovery, Davanloo developed a series of techniques that allow the resolution of disruptions that keep individuals trapped in their own thoughts and patterns of action. As a result, their return to health becomes possible.

In ISTDP, anxiety is not just a thought in the mind; it also refers to the physical discharge in the body. During psychotherapy, the focus is on the physical symptoms of anxiety and the emotions that are hiding behind anxiety.

Somatisation - Anxiety That Hurts

Patients experiencing pain with a psychological basis consistently dismiss the anxiety symptoms they experience. When faced with a stimulus that increases their tension, there is excessive activity of the parasympathetic nervous system, which attempts to reduce the excessive arousal from the sympathetic nervous system.

The activity of this system can cause various symptoms such as headaches, gastrointestinal problems, nausea, abdominal pain, diarrhea or constipation, and fatigue. Patients start to strongly believe that they are physically ill, and regular disruption of the balance of the autonomic nervous system can lead to illness.

The release of stress hormones - adrenaline and corticosteroids - leads to increased blood pressure and other consequences associated with constant stimulation, eventually leading to illness.

"Delusions" of the Body

Joyce McDougall, a renowned psychoanalyst, suggests that in psychosomatic states, the body behaves as if it has "delusions." Physiologically unfounded excessive activation of certain bodily functions occurs, which contributes to the development of these "delusions."

It is important to emphasise that psychosomatic symptoms cannot be exclusively limited to somatic illnesses since sometimes various ailments or physical damage can occur due to psychological factors.

This includes issues related to addiction, which serve as a psychosomatic attempt to cope with painful internal conflicts, as well as the susceptibility to infections and a tendency to engage in risky behaviors.

There is no doubt that observing and attempting to regulate anxiety is a valid path in regaining a healthy mental balance.

What is Anxiety?

The feeling of anxiety arises in response to the unconscious detection of a threat, accompanied by many symptoms of mental, motor, and autonomic stimulation. When these symptoms occur as a response to danger, we call it fear, but when they’re elicited by our emotions, we refer to it as anxiety. Anxiety signals that the emotions triggered by a stimulus somehow pose a threat to us.

The primary function of anxiety is to signal and prepare the body to deal with the threat. When the body is stimulated, we engage in one of three defensive actions: fighting the object perceived as a threat, fleeing from it, or surrendering to it. Facing what troubles us is a necessary practice for our health and development.

Avoidance may seem tempting, but we have to be aware that it comes at a high price in the form of anxiety, which can begin to control our lives. When it isn’t possible to attempt an escape from the difficult emotions we fear, we often try to camouflage them by using defense mechanisms.

Where does anxiety come from, and why do we suffer?

Maintaining relationships with others is one of the main conditions for human survival and development. After all, humans are social beings, and functioning within a community is an important part of our lives.

Emotions primarily arise as a result of relationships with people we love and care about. If, for some reason, parents can’t accept a child's emotions, it can result in a learned belief that emotions somehow threaten an important bond. As a result, the feeling that threatens the loss of that bond becomes a threat in itself and triggers anxiety.

To cope with this danger and with unwanted emotions, a child begins to use specific defenses. In doing so, they also learn to protect the people they love from the emotions they fear. A message is formed in the child's and later the adult's psychological system: "To maintain the bond, I have to hate my own emotions; I can’t show my true emotions."

Anxiety and the Suppression of Emotions

If we learn to suppress our emotions during childhood, we automatically and unconsciously repeat this pattern in adulthood. In a way, defense mechanisms save a child's life, but at the same time, they destroy an adult's life by preventing the regulation of anxiety, which begins to govern the body and produce physical symptoms.

Many patients with high levels of anxiety don’t even recognise this because while they were growing up, they learned to ignore their emotional states. The traumas they experienced in significant relationships with loved ones bring out anger towards the very people who should be loved—and who they do love.

These mixed emotions are often associated with very high levels of anxiety. To regain mental and physical health, patients have to recognise the anxiety, consciously focus on it for an extended period of time, discover their hidden emotions, and let themselves experience the anxiety.

Treatment for Somatisation

Although psychosomatic disorders have a psychological basis, it’s necessary to rule out causes related directly to the body in the first place.

This is crucial because anxiety symptoms and somatic illnesses can sometimes be very similar: headaches, gastrointestinal problems, dizziness, stomach pain, nausea, diarrhea, blurred vision, ringing in the ears, fainting, feelings of emptiness, scattered thoughts, loss of coherent thinking, memory problems.

That’s why it’s  extremely important for people experiencing suffering to be convinced that there are no medical causes for their health concerns. If, despite exhaustive examinations, no explanation for their physical discomfort is found, it’s time to seek help from a mental health specialist.

Somatisation - Self-Help Techniques

In addition to seeking professional help, self-help techniques are also crucial in minimising unpleasant symptoms. If a psychosomatic disorder is diagnosed, the following tips are important:

• adopting healthy habits such as a balanced diet, regular sleep, and sufficient rest,
• engaging in enjoyable physical activity,
• paying attention to the patient’'s own needs,
• taking emotions seriously - particularly recognising and accepting challenging emotions, allowing yourself to name them and experience them appropriately.

Being diagnosed with a psychosomatic disorder may initially be unsettling, but it’s important to remember that there’s nothing to be afraid of. Just as different specialists examine and treat different parts of our body, psychiatrists and psychotherapists can help identify the source of your mental health problems and find a path to recovery together.