Mind and body

What “Psychosomatic” Really Means

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It does not mean “imaginary.” In medicine, psychosomatic refers to the influence of psychological, social and behavioral factors on bodily processes. Influence is the key word: a factor that shapes how an illness starts or responds to treatment does not make the illness imagined, or mainly psychological.

What does psychosomatic medicine study?

The Wikipedia article on psychosomatic medicine describes it as an interdisciplinary medical field exploring how social, psychological and behavioral factors relate to bodily processes and quality of life. It is the forerunner of behavioral medicine and part of consultation-liaison psychiatry, and it draws on psychiatry, psychology, neurology, internal medicine and other specialties. In the field’s own literature, a 2016 review in Anales de Psicología by Berrocal Montiel, Fava and Sonino describes the psychosomatic approach as one that takes into account psychosocial factors affecting individual vulnerability, considers patient care as a whole, and integrates psychological interventions into medicine.

The article also describes a position it calls the strongest perspective in the field: that separating “purely physical” from “psychosomatic” illness is obsolete, because almost all physical illnesses have mental factors that influence their onset, presentation, maintenance, response to treatment and resolution. That is an encyclopedia’s summary of a position within the field, not a clinical finding, and it is a claim about influence, not cause.

What about the older distinctions?

Psychiatry has traditionally separated two ideas, according to the article:

  • Psychosomatic disorders: physical illnesses in which mental factors play a significant role in development, expression or resolution.
  • Somatoform disorders: conditions in which mental factors were thought to be the sole cause of a physical illness.

The article gives an example of how mixed the picture can be. Helicobacter pylori causes most peptic ulcers, yet most people carrying it never develop an ulcer, and some people with ulcers do not have the infection, which leaves room for psychological factors to play some role.

Does it mean the symptoms are not real?

No. The MSD Manual Professional Edition describes somatic symptom disorder as disproportionate and excessive thoughts, feelings and behaviors in response to physical symptoms, and states that the symptoms are not intentionally produced or feigned and may or may not accompany a general medical condition. The Wikipedia article on somatic symptom disorder adds that it replaced the older somatoform diagnosis and that the underlying cause of the symptoms, whether physical, psychological or unexplained, is irrelevant to the diagnosis. The disorder concerns how a person interprets and responds to symptoms, not whether the symptoms are real.

Why should you be careful with the label?

Because it is often reached by inference. The psychosomatic medicine article notes that it is difficult to establish for certain whether an illness has a psychosomatic component, and that one is often inferred when part of a person’s presentation is not accounted for by biological factors. That makes it a reasonable hypothesis, not a final verdict. The somatic symptom disorder article makes a related point about the older somatoform diagnosis: because it rested only on the absence of a medical explanation, anyone with a poorly understood illness could meet its criteria.

Can hypnosis help with psychosomatic symptoms?

On the psychological side of the picture, alongside medical care. The article notes that psychosomatic aspects of illness are often attributed to stress, which makes reducing stress one important factor in treatment and prevention. Hypnosis is one way to practice stress reduction, and for some conditions, such as irritable bowel syndrome, it has been studied in a gut-focused form.

Three questions to ask when a symptom is called psychosomatic

What has been tested and ruled out so far? What would make you look again for a physical cause? And which psychological or behavioral treatment would you suggest alongside any medical care? The answers turn a label into a plan.

This article is general information, not medical or psychological advice; talk with a licensed clinician about your own situation.

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