Can Mental Illness Cause Physical Pain?

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.)

and which cannot be accounted for by a known medical problem.

Whatever their cause, these are serious sorts of symptoms. It does patients who experience them a disservice to suggest that they are “just psychological” in nature (e.g., implying that they don’t really exist). Rather, these are real symptoms that really hurt. It is only that the processes that are causing these real symptoms are 1) poorly understood at this point in time, and 2) influenced by cultural and psychological factors so that their expression is atypical. People diagnosed with somatoform disorders are not “faking it” when they report their symptoms. They are just experiencing their disturbances in a different manner than do most other people.

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.