Aa
Psychic Groans - Anxiety or the Real Thing?
This topic of anxiety symptoms versus real ones has come up a couple times recently and I decided to do a blurb on "Somatization" or the appearance of symptoms that represent anxiety or psychiatric difficulty expressed as physical symptoms.
For the last week I have been doing reading and I will tell you that I come away both suspicious of the medical profession's take on this topic and confused about what I really know and what I want to believe.
I have always believed that people can express their fears, anxiety, and psychological pain with physical maladies. Afterall we all know by now that there is no real separation of the mind and body. As a pediatrician I saw babies children with vomiting and abdominal pain in response to parental fighting, or problems at home. Children with a parent with a back injury would begin to include back pain in their common complaints. My mother was a caretaker for my grandparents. My grandma was rather immature and always had vague complaints - as well as serious real ones. She would invariably end up in the ER within a day of any vacation my mother had planned.
We all know that some of this exists all around us. We all know people who truly live in great fear that every symptom they have is something dread and fatal. Or people that magically develop every symptoms they hear about. Okay. Those people do exist. But, I have also noticed that these people "know" they are anxious, but can't fight it.
I have to say, though, that after 30 years in medicine and another two on this forum, I am beginning to feel that there is a HUGE group of people out there with real disease that the medical profession is completely dismissing - all with good intentions. On one hand there is the recommendation to make sure people do not have something serious, but it is countered by equally strong recommendations to NOT "feed into people's neuroses" by doing a large workup.
When I look at the articles and psychiatric journals that describe this I tried to discern the characteristics of somatic complaints, the type of symptoms that they are calling somatic and how they presume to tell the difference.
First I looked at the lists of symptoms that are given as typical of somatic complaints:
Abdominal pain *
Amnesia
Back pain *
Bloating *
Chest pain *
Diarrhea *
Difficulty swallowing *
Dizziness *
Excessive menstrual bleeding
Fatigue *
Frequent urination *
Headaches *
Impotence *
Irritability *
Irregular menstruation
Joint pain *
Nausea *
Pain during intercourse
Pain during urination *
Pain in the legs or arms *
Palpitations *
Paralysis or muscle weakness *
Poor Balance*
Poor Memory *
Tingling in places*
Sexual apathy
Shortness of breath *
Vision changes *
Weakness *
* = things seen commonly in diseases like MS, Lyme Disease and Autoimmune disorders
I found the lists of symptoms completely unhelpful. Some lists led me immediately to a mental diagnosis of MS!
Then I tried to see what characteristics these symptoms seemed to have. This was "a little" more helpful. These are the things that frustrate the doctors caring for such people.
1) Symptoms are vague, yet described with very expressive and unusual language
2) Symptoms move around from place to place often, or they are fleeting. (I kind of agree with this one)
3) Sensations are felt "all over" with no ability to describe differences from one location to another. Examples, "I hurt all over." Or weak all over. Numb all over.
4) Symptoms that do not correspond with things found on exam. Example, the complaint that the legs are weak, but on exam the strength is completely normal or complaint of blurred vision, but acuity is normal.
5) Symptoms do not change, nothing improves them and no cause is found.
6) A history of many different symptoms for which a cause is never found and that eventually go away.
7) A recurring history of symptoms that occur when stressed, only to resolve.
I tried really hard to think through all of these characteristics and I was still not impressed that they were clues to somatic complaints.
The ones that I found most persuasive are 1) the complaints that are "global" and vague and constantly changing - hurting or numb all over without being able to pinpoint any differences (but, this can happen with people who are not very self-aware or who have poor skill in expressing themselves) 2) a patient's history that over years many complaints would come up and never be shown to have a cause, then would resolve only to be replaced by another, 3) the history that the symptoms dance around rapidly. Another big point here is that these people must never have suffered any kind of deterioration or disability related to their symptoms (but, of course this can be determined only in hindsight. This is not useful if you are looking at a disease which has a disappearing window for effective treatment.
But, when I thought about these points, they still didn't convince me that somatic disorders are widespread. Not all chronic diseases lead to disability. A person with Celiac Disease may just live their entire life with terrible abdominal symptoms (pain, diarrhea, bloating) but otherwise be pretty "healthy."
Another tip-off cited is when a person comes in with complaints in many different systems in the body. Uhhhh, does MS ring a bell? The hallmark of many autoimmune deseases and many infections, like Lyme Disease, is the vast nature of their possible symptoms. So, that criterion didn't impress me either.
Another tip off was "doctor-shopping." The history that the patient sought help from numerous doctors for their problems. This will be a whole discussion soon.
Finally, there was this "tip-off" that was frequently mentioned: The doctor finds himself frustrated and/or angry at the patient that seems to be wasting his time. If he's frustrated maybe it's because the patient doesn't have anything wrong.
So, what did I end up deciding? I still believe that many people have vague discomforts from internal stress. These come and go. But, I am more and more convinced that the medical profession is losing our confidence because of the diagnosis of "It's due to anxiety" is thrown out too fast and too early and is substituting for real thinking. And, too often real abnormal findings (on exam and tests) are ignored in the rush to blame it on the patient.
Finally most of the articles point out that all of the things that are mentioned above can also be seen in people with "real" disease. There are criteria for diagnosing people with somatic complaints. I have read them and need to find them again. And studies have been done to assure practitioners that the diagnostic criteria are quite accurate by following up with people and showing that they didn't actually have some real disease. The articles also comment on how hard it is to treat this "condition." Could this be because talk therapy doesn't undo real disease?
But, I still don't find that reassuring. In my mind our limbolanders might fit that "follow up", but does a lack of diagnosis "really" mean there isn't disease? For two years I was without a diagnosis after having been judged to be one of the Walking Worried. If you checked on me before I saw the right neuro you might have assumed that the diagnosis of "Somatic" was correct.
I am throwing these thoughts out for discussion. How do we know when we are having a "psychic groan" symptom? How does a doctor really know? How many of you have ever had a symptom that you were told was due to anxiety and you could see that it was likely true? When there are real abnormalities on exam, can the diagnosis of anxiety still be true?
The floor is open for discussion.
Quix
For the last week I have been doing reading and I will tell you that I come away both suspicious of the medical profession's take on this topic and confused about what I really know and what I want to believe.
I have always believed that people can express their fears, anxiety, and psychological pain with physical maladies. Afterall we all know by now that there is no real separation of the mind and body. As a pediatrician I saw babies children with vomiting and abdominal pain in response to parental fighting, or problems at home. Children with a parent with a back injury would begin to include back pain in their common complaints. My mother was a caretaker for my grandparents. My grandma was rather immature and always had vague complaints - as well as serious real ones. She would invariably end up in the ER within a day of any vacation my mother had planned.
We all know that some of this exists all around us. We all know people who truly live in great fear that every symptom they have is something dread and fatal. Or people that magically develop every symptoms they hear about. Okay. Those people do exist. But, I have also noticed that these people "know" they are anxious, but can't fight it.
I have to say, though, that after 30 years in medicine and another two on this forum, I am beginning to feel that there is a HUGE group of people out there with real disease that the medical profession is completely dismissing - all with good intentions. On one hand there is the recommendation to make sure people do not have something serious, but it is countered by equally strong recommendations to NOT "feed into people's neuroses" by doing a large workup.
When I look at the articles and psychiatric journals that describe this I tried to discern the characteristics of somatic complaints, the type of symptoms that they are calling somatic and how they presume to tell the difference.
First I looked at the lists of symptoms that are given as typical of somatic complaints:
Abdominal pain *
Amnesia
Back pain *
Bloating *
Chest pain *
Diarrhea *
Difficulty swallowing *
Dizziness *
Excessive menstrual bleeding
Fatigue *
Frequent urination *
Headaches *
Impotence *
Irritability *
Irregular menstruation
Joint pain *
Nausea *
Pain during intercourse
Pain during urination *
Pain in the legs or arms *
Palpitations *
Paralysis or muscle weakness *
Poor Balance*
Poor Memory *
Tingling in places*
Sexual apathy
Shortness of breath *
Vision changes *
Weakness *
* = things seen commonly in diseases like MS, Lyme Disease and Autoimmune disorders
I found the lists of symptoms completely unhelpful. Some lists led me immediately to a mental diagnosis of MS!
Then I tried to see what characteristics these symptoms seemed to have. This was "a little" more helpful. These are the things that frustrate the doctors caring for such people.
1) Symptoms are vague, yet described with very expressive and unusual language
2) Symptoms move around from place to place often, or they are fleeting. (I kind of agree with this one)
3) Sensations are felt "all over" with no ability to describe differences from one location to another. Examples, "I hurt all over." Or weak all over. Numb all over.
4) Symptoms that do not correspond with things found on exam. Example, the complaint that the legs are weak, but on exam the strength is completely normal or complaint of blurred vision, but acuity is normal.
5) Symptoms do not change, nothing improves them and no cause is found.
6) A history of many different symptoms for which a cause is never found and that eventually go away.
7) A recurring history of symptoms that occur when stressed, only to resolve.
I tried really hard to think through all of these characteristics and I was still not impressed that they were clues to somatic complaints.
The ones that I found most persuasive are 1) the complaints that are "global" and vague and constantly changing - hurting or numb all over without being able to pinpoint any differences (but, this can happen with people who are not very self-aware or who have poor skill in expressing themselves) 2) a patient's history that over years many complaints would come up and never be shown to have a cause, then would resolve only to be replaced by another, 3) the history that the symptoms dance around rapidly. Another big point here is that these people must never have suffered any kind of deterioration or disability related to their symptoms (but, of course this can be determined only in hindsight. This is not useful if you are looking at a disease which has a disappearing window for effective treatment.
But, when I thought about these points, they still didn't convince me that somatic disorders are widespread. Not all chronic diseases lead to disability. A person with Celiac Disease may just live their entire life with terrible abdominal symptoms (pain, diarrhea, bloating) but otherwise be pretty "healthy."
Another tip-off cited is when a person comes in with complaints in many different systems in the body. Uhhhh, does MS ring a bell? The hallmark of many autoimmune deseases and many infections, like Lyme Disease, is the vast nature of their possible symptoms. So, that criterion didn't impress me either.
Another tip off was "doctor-shopping." The history that the patient sought help from numerous doctors for their problems. This will be a whole discussion soon.
Finally, there was this "tip-off" that was frequently mentioned: The doctor finds himself frustrated and/or angry at the patient that seems to be wasting his time. If he's frustrated maybe it's because the patient doesn't have anything wrong.
So, what did I end up deciding? I still believe that many people have vague discomforts from internal stress. These come and go. But, I am more and more convinced that the medical profession is losing our confidence because of the diagnosis of "It's due to anxiety" is thrown out too fast and too early and is substituting for real thinking. And, too often real abnormal findings (on exam and tests) are ignored in the rush to blame it on the patient.
Finally most of the articles point out that all of the things that are mentioned above can also be seen in people with "real" disease. There are criteria for diagnosing people with somatic complaints. I have read them and need to find them again. And studies have been done to assure practitioners that the diagnostic criteria are quite accurate by following up with people and showing that they didn't actually have some real disease. The articles also comment on how hard it is to treat this "condition." Could this be because talk therapy doesn't undo real disease?
But, I still don't find that reassuring. In my mind our limbolanders might fit that "follow up", but does a lack of diagnosis "really" mean there isn't disease? For two years I was without a diagnosis after having been judged to be one of the Walking Worried. If you checked on me before I saw the right neuro you might have assumed that the diagnosis of "Somatic" was correct.
I am throwing these thoughts out for discussion. How do we know when we are having a "psychic groan" symptom? How does a doctor really know? How many of you have ever had a symptom that you were told was due to anxiety and you could see that it was likely true? When there are real abnormalities on exam, can the diagnosis of anxiety still be true?
The floor is open for discussion.
Quix
COMMUNITY LEADER
I've been doing a lot of research, following any and every lead i can find and i started to think about my mother who is dx with bipolar and prior to that it was called manic depression, dx back in the early 60's. For years and years every medical issues she has had is ignored or left untreated due to the assumption that its anxiety and depression related, that is until she's in a medical crisis. EG
1) Hypoglycemia - untreated, cause not investigated
2) Pancreatitis - untreated, she doesn't drink so why, cause not investigated
3) Kidney issues - UTI - self treated unless she goes into renal failure then medical intervention other wise medically untreated, cause not investigated
4) Emergency gall bladder removed, prior years of sx went untreated, cause not investigated
5) Anxiety - untreated, on antidepressant but still a major sx, cause not investigated (pattern of feeling anxious if skips meals), unresolved leads to feeling weepy & apathetic.
6) Depression, treated with Zoloft, feeling sad etc very rare sx, anxiety chronic see above
7) Chronic reflux - self treated, dx sx of anxiety/depression
8) Plurisy - dx common cold, caught late by ER,
9) Trouble breething - dx smoker cough & anxiety, she's never ever smoked, ER shadow on right lung early pneumonia
Absolutely everything has been dismissed as being anxiety and depression related, until she is at the ER and in crisis, only then has the medical reason been discovered and thats after years and years of having sx that have been passed off because she has a long standing dx of depression. Now i believe she has had enough 'real' medical issues to think her depression/ anxiety could be secondary, caused by something like an undx adrenal/thyroid issue, possibly auto immune, even lupus. She's not a worrier but sometimes its obvious that her fight or flight is on over drive, even menapause sx was not addressed because she couldn't tell the difference. It makes so much sense to me that there is more going on than depression/ anxiety that isn't being resolved by the taking of antidepresants.
Ok, genetic link maybe, my little boy was dx with anxiety, specifically panic attacks at the tender age of 4 and has been on Tofranil ever since so thats 8 years now. To be clear here, when we removed the foods he reacts to, the sx of panic attacks disapeared, it took years before any dr took the causation seriously, he's even still on the same dose he started with. After about 6 years of being panic free he ate his birthday cake which had more than a few ingredients he hasn't eaten for years. Within hours he's again describing those old feelings, and was drenched in cold sweat, sweat running down his back, chest and his hair dripping wet, clammy, heart visibly pounding, disorientated, needing to be close to mum, huge pupil's, excessive urination and feeling shaky and strange.
Long story sorry but i find it rather interesting that from oldest to youngest there is a common recurring theme, anxiety and depression is quickly dx even when there is a heck of a lot of 'real' evidence that points towards anxiety and depression being secondary to the medical issue that isn't being addressed or treated. I have no issue at all with anxiety or depression, they should be treated medically pronto! What i do have issues with is treating anxiety and depression and the medical complaint is still unresolved, shouldn't that be a red flag. If the primary cause IS anxiety or depression wouldn't the presumed phantom sx disapear or am i barking up the wrong tree with my way of thinking?
Ohhh brother i wrote a novel, whoops sorry!!! :-)
Cheers........JJ
1) Hypoglycemia - untreated, cause not investigated
2) Pancreatitis - untreated, she doesn't drink so why, cause not investigated
3) Kidney issues - UTI - self treated unless she goes into renal failure then medical intervention other wise medically untreated, cause not investigated
4) Emergency gall bladder removed, prior years of sx went untreated, cause not investigated
5) Anxiety - untreated, on antidepressant but still a major sx, cause not investigated (pattern of feeling anxious if skips meals), unresolved leads to feeling weepy & apathetic.
6) Depression, treated with Zoloft, feeling sad etc very rare sx, anxiety chronic see above
7) Chronic reflux - self treated, dx sx of anxiety/depression
8) Plurisy - dx common cold, caught late by ER,
9) Trouble breething - dx smoker cough & anxiety, she's never ever smoked, ER shadow on right lung early pneumonia
Absolutely everything has been dismissed as being anxiety and depression related, until she is at the ER and in crisis, only then has the medical reason been discovered and thats after years and years of having sx that have been passed off because she has a long standing dx of depression. Now i believe she has had enough 'real' medical issues to think her depression/ anxiety could be secondary, caused by something like an undx adrenal/thyroid issue, possibly auto immune, even lupus. She's not a worrier but sometimes its obvious that her fight or flight is on over drive, even menapause sx was not addressed because she couldn't tell the difference. It makes so much sense to me that there is more going on than depression/ anxiety that isn't being resolved by the taking of antidepresants.
Ok, genetic link maybe, my little boy was dx with anxiety, specifically panic attacks at the tender age of 4 and has been on Tofranil ever since so thats 8 years now. To be clear here, when we removed the foods he reacts to, the sx of panic attacks disapeared, it took years before any dr took the causation seriously, he's even still on the same dose he started with. After about 6 years of being panic free he ate his birthday cake which had more than a few ingredients he hasn't eaten for years. Within hours he's again describing those old feelings, and was drenched in cold sweat, sweat running down his back, chest and his hair dripping wet, clammy, heart visibly pounding, disorientated, needing to be close to mum, huge pupil's, excessive urination and feeling shaky and strange.
Long story sorry but i find it rather interesting that from oldest to youngest there is a common recurring theme, anxiety and depression is quickly dx even when there is a heck of a lot of 'real' evidence that points towards anxiety and depression being secondary to the medical issue that isn't being addressed or treated. I have no issue at all with anxiety or depression, they should be treated medically pronto! What i do have issues with is treating anxiety and depression and the medical complaint is still unresolved, shouldn't that be a red flag. If the primary cause IS anxiety or depression wouldn't the presumed phantom sx disapear or am i barking up the wrong tree with my way of thinking?
Ohhh brother i wrote a novel, whoops sorry!!! :-)
Cheers........JJ
I have to apologize that I didn't read through every post on this thread, but not only do I want to thank Quix for researching this topic, but what really stuck out in my head was:
"if you agree there is some underlying depression or anxiety, then treat it and see what is left."
I'm sure that many of us have gone through this. Are we crazy, are we not??? It's very hard to be in limbo and not know if we are really suffering from anxiety/depression or not?
Recently, after a year in limbo which was preceded by a very long streach of chronic daily headaches, the only advise I can really give is do not give up. And really, really listen to what the people who know you best observe. If it weren't for my hubby, I would have never gone for a sleep study that discovered three separate sleep disorders, which was an obvious cause of my horrifying fatigue.
And, I think "doctor shopping" is a good thing. Find someone that will listen. We all deserve that, despite the dx.
Love you all.
Heather
"if you agree there is some underlying depression or anxiety, then treat it and see what is left."
I'm sure that many of us have gone through this. Are we crazy, are we not??? It's very hard to be in limbo and not know if we are really suffering from anxiety/depression or not?
Recently, after a year in limbo which was preceded by a very long streach of chronic daily headaches, the only advise I can really give is do not give up. And really, really listen to what the people who know you best observe. If it weren't for my hubby, I would have never gone for a sleep study that discovered three separate sleep disorders, which was an obvious cause of my horrifying fatigue.
And, I think "doctor shopping" is a good thing. Find someone that will listen. We all deserve that, despite the dx.
Love you all.
Heather
WOW!!! WOW!!! WOWWWWWWWWWWWWW!!
THANKS FOR THE AWESOME ENTERTAINMENT!!! I SUCKED UP EVERY WORD, NOT A DROP LEFT!! lol
I BELIEVE EACH ONE OF US HAS A NATURAL INNER VOICE THAT MAKES US AWARE THAT SOMETHING ISN'T RIGHT.
TOO OFTEN WE KNOW SOMEONE WHO "IS" A WHINER /DRAMA QUEEN,
THEY TURNED US OR OTHERS OFF AND WE DON'T WANT TO BE THEM SO WE STAY QUIET OR IGNORE OURSELVES.
WE NEED TO LISTEN TO OURSELVES MORE AND QUIT PUTTING OFF MAKING THAT APPOINTMENT, BECAUSE "IT'S PROBABLY NOTHING" ,OR FEAR OF BEING TOLD SO. (ME)
I HAVE KNOWN SOMETHING WASN'T RIGHT FOR THE PAST 2 YEARS OFF AND ON. I WENT THROUGH 2 YEARS OF PURE HELL DURING THAT 2 YEARS W MY HUSBAND. I WAS QUITE SURE MY NURVES WERE SHOT .
I WENT TO MY FAMILY DOC AND TOLD HER HOW I WAS FEELING AND ASKED
FOR AN ANTI- DEPRESSANT AND A REFURAL TO A THERAPIST.
I'VE ALWAYS BEEN VERY HEALTHY AND STRONG, BUT I KNEW I WAS AT A PLACE WHERE I NEEDED HELP TO COPE.
I SAW THE THERAPIST A YEAR AND WAS OK, SO WENT OFF THE PILLS.
ALL ALONG THE WEIRD PAIN ON MY LEFT SIDE THAT CAME AND WENT, I CHAULKED UP TO WORKING TOO HARD.
UNTIL LAST MONTH THAT IS, THE BOTTOM FELL OUT OF MY BUCKET AND I HAVE TO ADMIT "I AM VERY SICK" I GUESS GOD HAS A REAL GOOD WAY OF GETTING OUR ATTENTION SOMETIMES WHEN WE WON'T SLOW DOWN LONG ENOUGH TO LISTEN!! LOL
I HAVE LEARNED SOMETHING GOOD ALREADY... IT'S OK TO REST AND LET THE RESPONSIBILITY REST ON OTHERS IN MY LIFE FOR ONCE. I'VE BEEN THE ONE TO "MAKE THINGS HAPPEN, OR THE FIXER UPPER..." NOW I CAN'T SO I DON'T HAVE TO. I'M SICK ENOUGH I DON'T MIND HOLDING STILL.
I'M READY TO MOVE ON BUT IN THE MEAN TIME I HAVE DECIDED TO ACCEPT
ALL THIS AND ENJOY THE VACATION FOR NOW
IT WOULD BE NICER W/OUT ALL THESE SYMPS, BUT THEN I WOULDN'T BE SITTING HERE WOULD I.... LOL NiCee
THANKS FOR THE AWESOME ENTERTAINMENT!!! I SUCKED UP EVERY WORD, NOT A DROP LEFT!! lol
I BELIEVE EACH ONE OF US HAS A NATURAL INNER VOICE THAT MAKES US AWARE THAT SOMETHING ISN'T RIGHT.
TOO OFTEN WE KNOW SOMEONE WHO "IS" A WHINER /DRAMA QUEEN,
THEY TURNED US OR OTHERS OFF AND WE DON'T WANT TO BE THEM SO WE STAY QUIET OR IGNORE OURSELVES.
WE NEED TO LISTEN TO OURSELVES MORE AND QUIT PUTTING OFF MAKING THAT APPOINTMENT, BECAUSE "IT'S PROBABLY NOTHING" ,OR FEAR OF BEING TOLD SO. (ME)
I HAVE KNOWN SOMETHING WASN'T RIGHT FOR THE PAST 2 YEARS OFF AND ON. I WENT THROUGH 2 YEARS OF PURE HELL DURING THAT 2 YEARS W MY HUSBAND. I WAS QUITE SURE MY NURVES WERE SHOT .
I WENT TO MY FAMILY DOC AND TOLD HER HOW I WAS FEELING AND ASKED
FOR AN ANTI- DEPRESSANT AND A REFURAL TO A THERAPIST.
I'VE ALWAYS BEEN VERY HEALTHY AND STRONG, BUT I KNEW I WAS AT A PLACE WHERE I NEEDED HELP TO COPE.
I SAW THE THERAPIST A YEAR AND WAS OK, SO WENT OFF THE PILLS.
ALL ALONG THE WEIRD PAIN ON MY LEFT SIDE THAT CAME AND WENT, I CHAULKED UP TO WORKING TOO HARD.
UNTIL LAST MONTH THAT IS, THE BOTTOM FELL OUT OF MY BUCKET AND I HAVE TO ADMIT "I AM VERY SICK" I GUESS GOD HAS A REAL GOOD WAY OF GETTING OUR ATTENTION SOMETIMES WHEN WE WON'T SLOW DOWN LONG ENOUGH TO LISTEN!! LOL
I HAVE LEARNED SOMETHING GOOD ALREADY... IT'S OK TO REST AND LET THE RESPONSIBILITY REST ON OTHERS IN MY LIFE FOR ONCE. I'VE BEEN THE ONE TO "MAKE THINGS HAPPEN, OR THE FIXER UPPER..." NOW I CAN'T SO I DON'T HAVE TO. I'M SICK ENOUGH I DON'T MIND HOLDING STILL.
I'M READY TO MOVE ON BUT IN THE MEAN TIME I HAVE DECIDED TO ACCEPT
ALL THIS AND ENJOY THE VACATION FOR NOW
IT WOULD BE NICER W/OUT ALL THESE SYMPS, BUT THEN I WOULDN'T BE SITTING HERE WOULD I.... LOL NiCee
My neuro thinks that anxiety is what's causing my elevated heartrate and shortness of breath on standing, or sitting upright from a reclined position.
Needless to say, I need a new neuro!
Needless to say, I need a new neuro!
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