Dr. Eva Reininghaus, University Clinic for Psychiatry, Psychosomatics, and Psychotherapy, Medical University of Graz, Austria: Yes, that is possible. In many cases, however, there are also physical causes for the complaints, but these are often not sufficient to explain the symptoms. This means that physical complaints can be triggered or exacerbated by psychological causes. This is particularly true when no sufficient physical causes can be found. A classic example is back pain: although there is a physical problem, the pain experienced often cannot be explained by this alone.

However, there are symptoms for which no physical complaints can be found even after intensive examination. One example of this is stomach ache in children. Often, psychological stress such as anger, sadness, or unresolved conflicts are behind it, i.e., a situation and an associated feeling that the child cannot cope with. This then manifests itself in physical complaints, even though there is no disease of the stomach or intestines. This phenomenon, which can also occur in adults, is referred to as “psychosomatic complaints” or “somatization.” The term “soma” means body, and it indicates that these complaints are actually felt physically, but no sufficient organic cause can be found.

Whether child or adult, those affected experience the symptoms as real pain. Those affected often feel misunderstood when their complaints are dismissed as “just psychosomatic.” They then frequently visit numerous doctors in the hope of receiving a diagnosis and treatment. The focus is on the physical symptoms, while possible psychological causes take a back seat.

In the case of stomach ache, everything is interpreted as stomach ache. Even minor digestive tract ailments, which everyone is familiar with, are attributed to stomach ache and the confirmation of a serious illness, and many sufferers thus become increasingly fixated on the complaint.

The body often reacts to psychological stress with complaints such as stomach ache, palpitations, or headaches. These symptoms often arise when emotional conflicts cannot be processed or expressed. For example, unresolved stress in a relationship can lead to persistent palpitations, even though there is no physical heart disease. If the underlying conflict is not addressed, the palpitations persist and those affected mistakenly suspect a serious illness. In fact, the symptoms are often an impairment in recognizing, experiencing, and expressing one's own feelings. As soon as the palpitations are linked to the marital conflict and the conflict can be addressed with the partner, the process of working through it has already begun, and the physical complaints often decrease as a result.

In order to receive treatment, those affected must realize that their symptoms are psychological rather than physical. By the time those affected seek medical advice, the problem has often been going on for a long time. In the case of palpitations, they would naturally be examined for all possible heart conditions. It is then often difficult for those affected to accept that their symptoms may have psychological causes. The path to this realization is often long, as doctors understandably look for physical causes first. Those affected have often already consulted many specialists without receiving a clear diagnosis. This repeated process, in which the symptoms are seriously investigated but no physical causes are found, often leads to frustration.

In addition, those affected research very carefully which diagnosis could fit their heart palpitations and exchange information with other patients. As a result, they are no longer mentally focused on their actual problem, which is that they are angry or sad because of the marital conflict, but instead think about possible heart diseases and their future life with the disease and become very absorbed in this topic.

The challenge is to convey to those affected that their physical symptoms are an expression of unresolved emotional conflicts. However, since doctors rarely have psychological training, this connection often goes unrecognized. This is a structural problem in our healthcare system: physical and mental illnesses are closely intertwined, but medicine is often not sufficiently prepared for this.

Recorded by Stefanie Flunkert