It's all in your head: psychosomatics and real diseases

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It's all in your head: psychosomatics and real diseases
It's all in your head: psychosomatics and real diseases

When it comes to strange symptoms associated with stress and other exertion, it is difficult to understand where it came from and why, for example, your hand is going numb. Let's try to figure it out.


For many reasons, the concept of so-called psychogenic symptoms is quite complex. There is a kind of stigma attached to her understanding: people believe that the brain can cause physical symptoms. This, in turn, complicates the diagnosis of the condition of potential patients. Because of this, results can vary widely and are difficult to communicate to patients. Often, psychogenic symptoms mask the underlying physiological diseases.

The complexity of psychogenic symptoms leads to the fact that some argue about their complete absence, supposedly the diagnosis is an excuse (this is a kind of way to accuse the patient of the incompetence of the doctor). However, the irony is that this approach is an excuse, as it tries to simplify a real and complex disorder.

What are psychogenic symptoms

Different terms have been used at different times to describe symptoms caused by psychological stress or other factors. Hysteria is an unfortunate term coined to give such symptoms an exclusively feminine connotation. For obvious reasons, the term "hysteria" is almost never used today. Often such symptoms are called psychosomatics, noting physical symptoms with mental reasons, but there is some bias here. Most often, the term "psychogenic" sounds - this is how they indicate mental causation.

A similar concept is somatogenic disorder. In this case, there is a physiological disease or disorder that provokes stress and anxiety, and they, in turn, generate psychogenic symptoms on top of physiological ones. In other words, the presence of even obvious psychogenic symptoms does not always mean that there is no physiological disease, so in this case, a thorough examination is still required.

Psychogenic or psychosomatic symptoms are real: the patient actually experiences them and often does not understand what their cause is. "Psychogenic" does not mean "fake": usually these symptoms are involuntary, a person simply cannot stop them. Psychogenic disorder is a real disorder, but the problem lies in the “software” of the brain, not in its “hardware”.

Sometimes people suffer from a depressive or anxiety disorder, which can be the result or cause of a biochemical brain disorder. With anxiety, the body is under a lot of stress - this disorder can easily manifest itself through physical symptoms, sometimes very serious. Even stress itself can manifest itself through physical symptoms.

The brain is the same organ of the body as any other. It consists of tissues and is connected to other organs through nerves and the neuroendocrine system. Thoughts can speed up the heart with an adrenaline rush, they can cause butterflies in the abdomen or trigger nausea by increasing vagal activity. Fear can lower blood pressure, which can cause a person to faint. And stress leads to chronic hypertension.

It turns out that each person, to one degree or another, manifests psychogenic symptoms, they just do not pay attention to them. So it is not surprising that, for absolutely psychogenic reasons, alarming symptoms can occur.

How to tell if symptoms are psychogenic

Critics of the psychogenic diagnosis argue that it is nothing more than a diagnosis of exclusion - in fact, indicating a lack of knowledge on the part of the treating physician. Ruling out underlying physiological causes is an important part of the diagnosis, but not the only one.

For example, in neurology, there are many situations where positive results can be used to show a patient that their symptoms may not be neurological. There is a symptom such as pseudo-convulsions or non-epileptic seizures, in which the patient experiences involuntary convulsive episodes. A seizure is an abnormal electrical discharge in the brain that hits neurons in unison and causes symptoms, depending on where it occurs. Seizures can have a certain number of patterns because they are "sloppy" and propagate directly to neighboring neurons (and do not follow complex networks of neurons). There are, for example, patterns of convulsive movement that are simply impossible due to motor seizures.

In addition, sometimes the patient may experience psychogenic weakness - partial or complete paralysis of the limb. True neurological weakness has characteristics that cannot be simulated (voluntarily or not), while there are techniques in neurological examination that can reveal such characteristics. In fact, during a neurological examination, different causes of weakness show different characteristics.

Without a detailed knowledge of neuroanatomy in a patient with psychogenic symptoms, they will be distributed, not corresponding to the anatomical pathways. Or they will exhibit patterns of movement that do not correspond to any part of the motor system.

Another feature that indicates (but not absolutely accurately) a psychogenic disorder is the absence of concomitant neurological deficits. This includes reflexes that do not require cooperation, voluntary efforts, or the patient's subjective response.

In other words, there are cases when a person exhibits neurological symptoms that seem to disrupt neuroanatomy, reveal signs of effort, do not correspond to known systems in the nervous system and do not contain objective data that should, in theory, be present. Even then, exhaustive research is needed to uncover the underlying problem. In the case of psychosomatic disorders, it is necessary to undergo an MRI scan and physiological tests for the functioning of the nervous system.

When signs of a psychosomatic disorder appear, but there are no obvious reasons for it, the diagnosis of a psychogenic or psychosomatic disorder is quite appropriate. This does not mean that the doctor misjudges the patient - on the contrary, he is trying to make an accurate diagnosis.


The brain is an organ like everyone else and can show symptoms in a variety of ways. Psychogenic causes are another point in the differential diagnosis. As described above, psychosomatic symptoms are not fake. A person actually experiences such symptoms, but they can be associated with diseases that put his body under a heavy load, because of which the brain "failed". Whatever the problem in the end turns out to be, you should trust a specialist and undergo a thorough examination.

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