Can An Illness Really Be 'All In Your Head'?

Have you ever experienced a headache or chest pain when you're under a lot of stress? Or suddenly developed heartburn or an upset stomach when you're anxiously waiting for a test result or after having a heated discussion with a loved one? It's no surprise that stress can have an impact on your body, even if you don't realize it's happening or where that awful headache is coming from.

In most cases, however, these are temporary symptoms — once the stressful situation is resolved, you will start feeling better physically too. Even in cases of long-term stress, symptoms like headaches don't last forever, but rather come and go.

But what happens if things don't get resolved? Chronic stress and worry can be challenging, but are they enough to make you sick? Or is your mind powerful enough to create long-lasting physical issues that could fool not only doctors but even yourself?

For people with psychosomatic disorder, the answer is yes; it really is "all in their heads." In a live interview published by NPR, neurologist Dr. Suzanne O'Sullivan, author of the book "Is It All In Your Head: True Stories Of Imaginary Illness," describes psychosomatic illness as "a disorder in which people get real physical symptoms that cannot be explained by physical examination or medical tests." 

Somatic symptom disorder, the name given to psychosomatic disorder by the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," affects up to 7% of the population and it's seen more commonly in women, according to the Cleveland Clinic. The problem with recognizing it is that it can present a wide variety of symptoms and affect different parts of the body. Somebody suffering from it can experience fatigue, headaches, aches and pains, and insomnia. In more serious cases, people might present with high blood pressure and stomach ulcers. The symptoms are real and the patient is truly suffering — but after medical tests and a lot of searching for answers, there's no physical explanation for what the person is experiencing.

In extreme cases, the disorder has been associated with an increased risk of suicide, an obsession with checking the body for signs of illness or abnormalities, and the inability to function in daily life (per Mayo Clinic).  

So what exactly causes psychosomatic disorder? The short answer is that doctors don't know, and in many cases, they simply aren't equipped to deal with an ailment that's not physical, according to Dr. O'Sullivan.

Doctors don't know exactly what causes psychosomatic disorder, but there are certain factors that put you at a higher risk for it. According to Mayo Clinic, that includes both genetic and environmental factors. For example, if you are extremely sensitive to pain or have experienced a lot of stress or trauma, you might be more likely to develop psychosomatic disorder. Other risk factors include already suffering from anxiety or depression and growing up in a family with a history of a specific disease and being afraid you might develop it too.

Doctors usually arrive at the diagnosis of somatic symptom disorder after they have exhausted tests and exams and have not found a medical diagnosis for the physical symptoms. Having a history of excessive visits to doctors could also be a red flag that something else is happening (per Cleveland Clinic). Mayo Clinic also points out that groups with a lower education level or those with a poor socio-economic status are also at a higher risk of developing somatic symptom disorder. 

Professional mental health care is required to deal with psychosomatic disorder. Depending on how serious the situation is and what's behind it, a person might benefit from therapy (especially cognitive behavioral therapy) or medications, including antidepressants. Home care includes finding a support system and ways to deal with stress, whether that means meditating, exercising, or sleeping more, according to Cleveland Clinic.