Psychosomatic symptoms are physical symptoms whose course or intensity may be influenced by psychological and social factors. The term “psychosomatic” describes interactions between mental and bodily processes, but it is not the name of a single diagnosis.
Pain, dizziness, fatigue, palpitations, digestive difficulties, breathlessness and other symptoms are real whether or not a complete medical explanation is immediately found. Normal results from standard investigations do not mean that a person is inventing their symptoms or can stop them through willpower.
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How the body and mind can interact
Biological, psychological and social factors can all influence health at the same time. Illness, previous injury, nervous system functioning, medication, sleep, physical activity, prolonged stress, anxiety, low mood and life circumstances may alter how symptoms are experienced and how they develop.
Stress or emotional difficulties should not automatically be treated as the sole cause of a physical complaint. They may intensify symptoms, help maintain them or make recovery more difficult, but each situation requires an individual assessment.
Symptoms that may need assessment
- recurrent or persistent pain;
- fatigue, sleep disturbance or difficulty concentrating;
- dizziness, weakness, tremor, numbness or movement difficulties;
- palpitations, breathlessness or tightness in the chest;
- nausea, abdominal pain, changes in bowel habits or other digestive symptoms;
- symptoms that worsen during periods of stress or substantially limit everyday life.
This list does not establish a diagnosis. These symptoms can have many causes, so new, unusual or persistent symptoms should be discussed with a doctor.
Assessment of psychosomatic symptoms
Assessment usually begins with a GP or the relevant medical specialist. The clinician asks about the nature and duration of symptoms, previous health conditions, medication, sleep, activity, emotional wellbeing and the effect of symptoms on daily life, and carries out an appropriate physical examination.
Blood tests, imaging or other investigations are arranged when indicated rather than according to the same sequence for everyone. Their purpose is to identify or rule out physical causes and decide whether another specialist should be involved. When medical findings do not fully explain the symptoms, this does not by itself prove that their origin is psychological.
Clinicians may use specific diagnoses such as somatic symptom disorder or functional neurological disorder. These have different criteria and are not three forms of a single “psychosomatic disease”. A trained professional makes a diagnosis from positive clinical features and the complete clinical picture, not simply because investigations are normal.
New or changing symptoms
Even when a functional or stress-related condition has already been diagnosed, new symptoms, a clear change in their pattern or rapid deterioration require further medical assessment. New complaints should not automatically be attributed to a previous diagnosis.
Urgent help is needed for sudden severe chest pain, marked breathlessness, fainting, new weakness on one side of the body, difficulty speaking, vomiting blood, a sudden extremely severe headache, suicidal thoughts or another acute condition. In Ukraine, call 103 or 112.
Treatment and support
Care depends on the particular symptoms, diagnosis, coexisting conditions and individual needs. A clear explanation of the assessment and an agreed follow-up plan are important, rather than repeating investigations without a new indication or leaving the person without support.
The plan may include treatment of an identified physical condition, gradual return to activity, sleep support, physiotherapy or rehabilitation, strategies for managing particular symptoms, and psychological or psychotherapeutic support. Psychological therapy can reduce distress, change responses to symptoms and support everyday functioning, but offering it does not mean that the symptoms are “not real”.
Medication is used only for specific indications, such as an identified physical condition, a coexisting anxiety or depressive disorder, or particular symptoms. There is no single medicine for every psychosomatic presentation.