We’ve probably all experienced physical reactions to psychological triggers. That hot flush that creeps across your cheeks when embarrassed; the gut-wrenching nausea that hits when you receive bad news; palpitations when nervous…

These are known as ‘psychosomatic’ physical symptoms where there’s no obvious medical cause, and so it’s believed that psychological or emotional factors are to blame.

As consultant neurologist Suzanne O’Sullivan demonstrates in her book, It’s All In Your Head – which has just scooped the Wellcome Book Prize 2016 – psychosomatic illness goes far beyond stomach butterflies and aches and pains that get worse when you’re worried.

For some, it can be as devastating and debilitating as the ‘medically diagnosable’ conditions that symptoms mimic – and she hopes the book will get people talking, and highlight the need for better services and support.

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A hidden problem

“Psychosomatic disorders are really, really common, but for some reason, people don’t talk about them; it’s a hidden problem,” says O’Sullivan. “To think that one in three people in a neurology clinic have this sort of disorder - and yet most people have never have heard about it – is really shocking.”

Real illness

It’s easy to dismiss psychosomatic problems as purely ‘imaginary’ or ‘pretend’, but O’Sullivan points out that it’s far more complex than that, and should be recognised as a “very real” condition.

Take Camilla, a successful lawyer and mum-of-two whose life is plagued by seizures despite the fact tests all come back negative, and Yvonne who goes blind although nothing’s wrong with her eyes – two examples highlighted in O’Sullivan’s book, which weaves true stories based on her encounters with patients, and knowledge and insights garnered during her years working at the Royal London Hospital, and now at the National Hospital for Neurology and Neurosurgery.

Psychological routes

It’s eventually revealed that Camilla and Yvonne’s symptoms are rooted in emotionally traumatic experiences from their past. How these come to manifest in such extreme physical ways is an area that remains relatively mysterious – but there is real science to it, and O’Sullivan notes that researchers are now “much closer” to understanding the brain processes involved.

Emerging science

“The UK is actually very advanced in this, [but] it’s only been in the last five to 10 years that there’s a group of doctors now examining this with proper scientific rigour,” she says, adding that technology such as MRI scans sometimes enable doctors to see differences that distinguish somebody who is “psychogenically paralysed from somebody who’s pretending to be paralysed”. It’s believed that in psychosomatic illness, the brain has “retrained” itself to experience symptoms as though they are real.

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Dismissed by doctors

And it’s not just public awareness that’s lacking – O’Sullivan is frustrated by the lack of knowledge and support within healthcare services too.

“In a lot of medical clinics, if they say your disorder is [psychosomatic], it feels like a dismissal. Medicine stops at a point where we say, ‘Well, you don’t have this or you don’t have that’,” she explains, adding that doctors need to work together to recognise psychosomatic illness as a genuine need for follow-up, and develop care pathways so patients can get the support they need. 

Taboo topic

“We already know that mental health is stigmatised. I think this is even more stigmatised, because of that fact that it looks physical but actually it’s psychological, and that makes it really hard for people to recognise that it’s a real problem,” adds O’Sullivan.

Lack of acknowledgement by doctors can add to this sense of stigma and isolation – and mean that people become trapped in impossible-seeming circumstances, where their symptoms remain a problem for them but aren’t being addressed.

“If somebody is having seizures everyday, the fact [tests show] they don’t have epilepsy is irrelevant to them,” O’Sullivan stresses.

“Can you imagine how it feels if you are having 10 seizures a day, or you’re in a wheelchair, and you perceive that a doctor’s told you there’s nothing wrong with you?”

Have you experienced symptoms that were deemed psychosomatic? Tell us about it in the comments below.