What is it?
All emotions have a physical part. We may have tears when we are sad and breathe faster when afraid. "Soma" is the Greek word for body. "Somatization" is the word we use for the physical (or body) expression of stress and some emotions - it's the medical term for the mind body connection. We all somatise. In fact, up to 12% of doctors' visits are for symptoms affected by somatization. Somatic symptoms are very real. Everyone experiences somatization, but, for some people, it gets in the way of everyday life and requires treatment.
How does somatization happen?
There are a few ways that somatization can start. It can happen on its own or as part of a medical condition. Emotions and stress may cause the physical symptoms. For example, Sarah is a high-achieving and responsible teenager who has a small and close group of friends. She recently started middle school and was put in an enriched class for students with strong academic skills. In October, Sarah began having fainting episodes; she would slump over in her desk or fall to the ground. These episodes happened up to twenty times a day. No medical cause was found.
Emotions and stress may make the symptoms of a medical condition stronger or more intense. For example, Leo was diagnosed with ulcerative colitis, an inflammatory bowel disease, several years ago. He has had many treatments at the hospital and currently his IBD is well controlled. Leo and his parents notice that when he experiences anxiety or stress, for instance having a fight with his parents or working on a big school project, his gastro-intestinal symptoms worsen.
And sometimes a medical illness can cause anxiety and distress, which then leads to somatic symptoms. For example, Raj is an athletic teenager who plays competitive soccer and hopes to be on a university team in the future. During the soccer season, Raj suffered a concussion. As a result, he had headaches, problems concentrating, tiredness and sensitivity to light. He missed a month of school and playing soccer with his team. The symptoms went away, but during spring break, his headaches returned. Raj was not able to re-join the team in time for the end-of-season play-offs.
This connection between emotions and physical symptoms is called the mind body connection.
Mind-body connection explained
The fight-flight-or freeze response is a great example of the mind-body connection. When we sense that we are in danger, a very powerful physical response is triggered. This can happen when we feel scared and there is a major danger present. It may also happen when we feel scared or stressed and the "danger" is not life threatening.
The nervous system has two main parts:
- the sympathetic system
- the parasympathetic system
These two systems are always acting in balance. The sympathetic nervous system is like a gas pedal in a car - it tells your body to get going. The parasympathetic nervous system, on the other hand, is like the brakes in a car - it tells the body to calm down. The fight-flight-or-freeze response is the sympathetic nervous system sounding the alarm.
The body's fight-flight-or-freeze response all starts with your ears, eyes and nose picking up on a danger signal. Your brain makes sense of that incoming information and decides what to do. Then your brain sends signals to your body, using electrical and chemical signals. These signals tell your body to stay alert and be ready to act quickly. For example, your heart beats faster, your muscles tense up, your pupils dilate and your stomach slows down to get you ready for action. This helps you survive danger by fighting or escaping (flight). All of these physical reactions happen quickly and without you even knowing it. Later when the danger is gone, your parasympathetic system kicks in and tells your body to calm down.
It is important to remember that these 'fight or flight' physical symptoms are not dangerous but they can be very powerful.
There are two main types of disorders affected by somatization:
- Somatic symptom disorder. Children and youth with this disorder may have body symptoms like:
- pain in abdomen (belly)
- chronic pain
- Conversion disorder (functional neurological symptom disorder). Children and youth with this disorder may have neurological symptoms like:
- weakness or paralysis
- dizziness or fainting
- abnormal movements (that may look like epileptic seizures)
- trouble with speech
- tingling or numbness
- memory loss
Often, people do not fit into one of these disorders, but their physical symptoms are still related to somatization. This means that they may have a medical illness like migraines, but stress and certain emotions make the physical symptoms more intense or happen more often. So we sometimes say that somatization is a part or component of the medical condition. Or that a child has a strong mind-body connection along with their physical symptoms.
It can be difficult for parents and families to hear that their child or youth's physical symptom is related to somatization. They may worry that the health care providers think "it's all in the child's head", that the child is "faking it", or that "there's nothing that we can do". They may feel lonely, frustrated and misunderstood.
What can be done?
It's important to have a doctor check any new physical symptom for an injury, infection, tissue damage or inflammation. But, when the symptom is related to somatization, it is also important to begin treatments for somatization. This may avoid unnecessary tests or treatments that can cause side effects and problems.
We call this "walking two paths" to follow a mind-body connection treatment path, and to continue a medical path as needed.
There are very good and effective treatments for somatization. The treatments are not the same for everyone. The best treatment involves a team that understand the emotional and physical impact of the person's symptoms.
Team members may include:
- family doctors, pediatricians or other medical specialists
- therapists, psychologists or counsellors
- occupational therapists
- social workers
- complementary and integrative medicine providers (massage therapists, acupuncturists)
Usually, each team member provides a different part of the treatment. The amount of time each member spends with the child or youth will depend on the stage and focus of the treatment. The team works together with the child and family to decide what treatment to provide by what team member at the right time.
Treatment has many goals and may include:
- mind-body strategies
- therapy and counselling
- physiotherapy and rehabilitation
Treatment helps the child or youth learn to manage their physical symptoms and return to wellness. Children learn to recognize what causes them stress, how their body reacts and how to manage it. Families may learn how to prevent somatization from disrupting life. The team also works with the child and family to help with things like getting back to school and activities and connecting with friends as much as possible.
Do children with these disorders get better?
Yes! Many of the symptoms that are caused by somatization go away on their own. If these symptoms last more than a few weeks or months, they may need more active treatment. With treatment, some children are symptom free. Others may continue to have symptoms for some time, but will be able to function better in daily life. Many youth say that this journey helped them learn a lot about themselves and develop good coping strategies and tools for life.