Psychosomatics: how stress shows up in the body and what helps

Your head aches by evening, your stomach churns before an important meeting, your heart suddenly races even though the cardiologist said everything is fine. In situations like these many people hear: “It’s psychosomatic” or “You have VSD.” Here is what is actually known about the link between stress and the body, where the myth begins and what helps.

Psychosomatics is the link between mind and body: our emotions affect how the body works, and physical illness affects our mood. This is not made up, and it does not mean “it’s all in your head”. When a symptom is linked to stress, it is real: the pain really hurts, the heart really beats faster.

Under stress the body gets ready for danger: it releases adrenaline and cortisol, muscles tighten, breathing speeds up and digestion slows down. After a short burst of stress everything settles again. But when stress goes on for months, it is as if the body never switches off the alarm.

How stress shows up in the body

The link with stress is well known for these symptoms:

• Tension headaches: a pressing pain on both sides of the head, as if a tight band were round it. Stress, lack of sleep and caffeine are among the common causes.
• Muscle tension and pain, especially in the neck, shoulders and back, and a clenched jaw.
• The gut: pain, bloating, changes in bowel habits. In irritable bowel syndrome, stress often makes symptoms worse.
• Palpitations: stress and anxiety are among the common triggers.
• Sleep: trouble dropping off, light sleep, no energy in the morning.
• Dizziness, feeling short of breath, a lump in the throat.

But stress is not the only cause of these symptoms. The same sensations can come from thyroid problems, anaemia, heart rhythm problems, bowel conditions and some medicines.

The myth of “tables of causes”

Tables in the style of Louise Hay are popular online: every illness supposedly has a hidden emotional cause. A sore throat comes from words left unsaid, back pain from the weight of responsibility, a tumour from buried resentment. There is no scientific evidence behind these tables.

They do harm in two ways. First, someone may put off seeing a doctor and miss an illness that is very treatable when found early. Second, they shift the blame onto the person who is ill. The thought “so it’s my own fault I’m ill” adds shame, and shame heals nothing.

Stress can make symptoms worse, but illnesses usually have many causes: genes, infections, lifestyle, age. No single emotion is “responsible” for a particular organ.

A doctor first, then a psychologist

If a physical symptom worries you, start with a doctor. A sudden severe headache, chest pain, breathlessness or fainting need help the same day, and if your life is in danger, call 911. Blood in your stool or weight loss you cannot explain also need a doctor soon, without waiting for it to pass.

Tests that find nothing are not a waste of time: they rule out anything dangerous and give the work a clear starting point. If the doctor has found no illness that explains your symptoms, it does not mean you are pretending. It means it is worth looking at stress, anxiety and how you live. Often you need both: treatment from your doctor and work with a psychologist at the same time.

VSD and “neurosis”: symptoms and what lies behind the words

If you grew up with post-Soviet healthcare, you may have been told you have vegetovascular dystonia (VSD). But there is no such diagnosis in the International Classification of Diseases, neither ICD-10 nor ICD-11, and it has no generally accepted criteria. It is a label used mainly in post-Soviet medicine. Behind it there is often an anxiety disorder, panic attacks, depression, headaches or sleep problems, and sometimes a physical illness that needs its own treatment.

Doctors use the word “neurosis” less and less too: modern classifications describe specific conditions, such as generalised anxiety disorder or panic disorder.

If you recognise attacks of a pounding heart and fear of dying, constant worry, tension and sleepless nights, don’t settle for “VSD”: look at the anxiety behind it. Anxiety responds well to treatment.

Psychosomatic symptoms: what helps

• Cognitive behavioural therapy (CBT). It helps you notice the circle of “symptom, fear, more tension, a stronger symptom” and step out of it. In irritable bowel syndrome, research supports CBT and other psychological therapies. With multiple physical symptoms, CBT also reduces them, although the effect is modest.
• Working with the body. In my practice this is body-oriented therapy: we learn to notice tension before it turns into pain, and to let it go.
• Breathing. Slow breathing, with the out-breath longer than the in-breath, helps many people calm the body.
• Sleep. A fixed wake time and a quiet last hour before bed.
• Movement. Walking, swimming, stretching: whatever you can manage and enjoy.
• Less caffeine and alcohol, if you notice they make your symptoms worse.

If you need medicine, a doctor prescribes it. Don’t start or stop medicines on your own.

Where to start

On this site you can take the PSS-10 (stress level) and HAM-A (anxiety in the body) tests; they take a few minutes. The tests don’t give a diagnosis, but they help you see how much tension has built up. If you would like to work out together what happens in your body under stress, book a free 15-minute intro video call and we will talk about where to begin. My sessions are held in Armenian or Russian, online or in person in Yerevan.