Summary
A reader asks whether mental health difficulties can accompany pain, numbness, brief altered responsiveness, and other concerning symptoms. The reader wonders whether a medical condition is more likely.
The response explains that psychological factors can accompany genuine physical symptoms, while warning against dismissing them as imagined.
It emphasizes medical assessment and, where appropriate, specialist evaluation before assigning a psychological explanation, acknowledging that understanding of physical conditions changes over time.
Question
Reader · Identity withheldHave you ever heard of any cases of mental illness that are associated with neck and back pain?
Also, what about cases where a person suddenly stops paying attention, experiences numbness in their hands and feet, has slurred speech, and needs to be prompted to respond, but then returns to normal after a few moments?
The only symptom that might be mental is that they report seeing figures and interacting with them. Can mental illness cause physical pain and these kinds of symptoms, or is this more likely to be caused by a medical condition?
Answer
Allan Schwartz, Ph.D.This is a wonderful question. There are indeed mental illnesses that can cause people to experience pain, numbness and a variety of other “physical” symptoms. They are known as Somatoform Disorders.
You’re probably familiar with a mild somatoform disorder, known as hypochondrias, which can be said to be occurring when you have a person who believes he or she is physically sick all the time in the absence of any evidence of real physical ailment.
The DSM (the manual of mental disorders) describes several other somatoform disorders of varying severity, including Somatization Disorder, Conversion Disorder, and Pain Disorder. While pain disorder is fairly straight forward to understand (there is pain that cannot be explained by an underlying medical condition), Somatization and Conversion Disorders are more complex, involving a collection of symptoms which may include:- Pain in particular locations (headache, abdomen, back, joints, extremities, genitalia, etc.)
- Gastro-Intestinal upset (stomach, intestinal, gas, nausea, vomiting, diarrhea, etc.)
- Sexual problems (pain during penetration, lack of interest, erectile dysfunction, menstrual problems, etc.)
- Pseudo-neurological problems (impaired coordination or balance, paralysis, muscular weakness, blindness, hallucinations, etc.)
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- Poorly understood at this point in time.
- Influenced by cultural and psychological factors so that their expression is atypical.
The more general process of transforming a mental pain into a physical pain is sometimes referred to as somatization (“soma” meaning body, probably in Latin). Some cultures seem to be more prone to somatic presentations of mental pain than others. I am told that many Hispanic cultures have a difficult relationship with depression, seeing it as a grave personal weakness instead of a simple disease.
In such a cultural environment (so I am to understand – I have not experienced it directly) it is not uncommon for people to come to you (as a doctor) and complain of physical sensations (pain mostly, but also numbness or weakness or sexual problems) when really their “problem” is that they are depressed. This same sort of thing happens with people from most any culture on an individual basis as well. A number of chronic pain patients start feeling somewhat better when you treat them for depression, for instance.
It needs to be said also that sometimes we think a disorder is somatoform, when it really is a physical disorder that we just didn’t know much about before. So it is with the case of fibromyalgia, which appears to be a real disease condition now, but which was formerly thought to be “in your head”. Scientific understanding of disease conditions changes over time, and old categories and distinctions need to be altered to fit as this occurred.
Last but certainly not least: If the person you describe as “they” above in your letter has not yet been checked out by a medical doctors, it is beyond time that he or she be seen. If they have been seen by a medical doctor who has ruled out any easily observed physical cause, he or she needs to be seen next by a psychiatrist, or a neurologist; some specialist who will be able to establish their diagnosis (or not) as a somatoform patient and offer reasonable treatment. Just because symptoms don’t appear to have a physical basis that doesn’t mean that patients who experience them don’t require treatment! Far from it, the person you describe would appear to have serious issues and to be in a position to really benefit from professional help. Please help this person to get the help they need.
