Your Therapy

Somatization causes and risk factors

Even though I’ve discussed somatization (also known as conversion disorder, somatic symptom disorder, functional neurological disorder etc.) several times, I still get a lot of questions about it. So this time I’d like to talk about a few misconceptions and risk factors, along with some examples, including one from my own life.

What is somatization?

Simply put, somatization occurs when psychological concerns are converted into physical symptoms. These symptoms have no discernable organic cause, and can be a source of great distress, interfering with a person’s day-to-day life. One of the biggest misconceptions is this: People often think that somatization must result from an experience that’s very serious, traumatic and psychologically devastating. But that’s not the case at all. Instead, somatization is caused by feelings that are difficult to talk about. somatization

The difference is subtle, but important. In my practice at Toronto’s SickKids hospital, I often worked with young people experiencing somatic symptoms. Some of them had indeed experienced deaths in the family, bullying, abuse and other major traumas. But there were also many who developed somatic symptoms while struggling with a feeling that they weren’t good enough, often in regards to schoolwork.

For example, I had a client in her early teens who had always easily excelled in school, and was admitted to the extremely challenging International Baccalaureate program. Shortly after switching schools to begin the program, she started having debilitating symptoms, including non-epileptic seizures, to the point she had to be hospitalized. When she was referred to me, I made a timeline of when her symptoms occurred, looking for possible traumatic or triggering events. (Treating somatization, by the way, requires both detective and therapeutic work.) Before too long, it became apparent that her symptoms were caused by the immense family and cultural pressure she felt to excel at her new school, even though she was outwardly positive about it. The key point, is that somatization is not caused by what you or I think is stressful—it’s about how that individual experiences stress.

I’m not immune to this myself. Last year my daughter was accepted at an out-of-province university, 3,000 kilometres away. I was very happy for her, and proud of her. But for six weeks before she left, I had a headache every single day. Then, the day before she boarded her plane, I woke up in early morning and realized I’d been more worried about her than I’d been willing to admit, and that I’d miss her terribly. But once I recognized and processed these feelings, the headache started to go away.

Reducing risk factors

Since somatization, to a large extent, comes from suppressing difficult emotions, people who tend to avoid verbalizing their feelings are most at risk. The best way to lower your risk is by talking to someone, somewhere about complicated feelings you may be experiencing. Keeping some things to yourself is fine, and even bottling up everything can work for many years—until one day, it doesn’t.

It’s also important to recognize that most feelings aren’t “bad” or “good.” We need to acknowledge that emotions are complicated, and we live in a world of greys. Even the most wonderful situations can prompt very mixed emotional responses. You might get your dream job, but along with the excitement comes a high level of stress and worry. Or, although you love your kids, they make you tired and cranky. Or, you may be proud of your daughter leaving home for the first time, but secretly despondent to see her go. Whatever the cause, we need to acknowledge and express these difficult thoughts and feelings, in order to have a healthy emotional life and, hopefully, reduce the likelihood of this mental-health challenge.

Thanks for reading and, as always, please feel free to reach out with questions about treatment for panic attacks, anxiety therapy,  somatization or other mental health issues.

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