How does extreme emotional pain feel?

When the pain comes from the psyche

If the somatoform pain disorder persists, mental problems cause physical pain.

It feels like a huge fist is crushing my head, "says Romana B. (65), describing the pain that ruled her life for years. Pain that drove her into the practices of many doctors, who admittedly did not know what to do with the catfish woman's suffering. Physically everything seemed fine, her findings were normal.

As the probable cause of her pain, the retired woman's psychological suffering came more and more to the fore. Because the pain first appeared at the time when she had little to laugh about. Her husband, unable to cope with the pressures at work, started drinking. A frustrated drinker had quickly turned into a heavy alcoholic. Day after day she had tried to get him off the alcohol, to save him. Over six years, in vain. “His illness made me sick too,” says the pensioner.

The divorce in 1994 did not bring the hoped-for redemption. “He continued to hit me,” she says. Even his death in 2003 did not let her rest, in dreams he was still with her. The pain was accompanied by high blood pressure and a constant feeling of intense tension.

One of the doctors Romana B. consulted eventually gave her problem a name: persistent somatoform pain disorder (ASD). This is characterized by pain lasting at least six months without a physical (somatic) cause that could explain the extent of the pain. “The term, somatoform‘ means that the disorders look as if they were caused by the body, but according to the current state of knowledge, they are not. However, those affected are convinced that they have a physical disorder, ”explains Linz psychotherapist Hans Morschitzky.

Triggers are psychological circumstances (emotional conflicts, psychosocial problems). Women are more often affected than men. The disorder occurs more frequently between the ages of 30 and 50 years. The pain either affects only one region of the body or several regions at the same time (such as head, shoulder, back, arm, chest, stomach or legs). Frequent side effects are gastrointestinal complaints, exhaustion, sleep disorders, dizziness, tension and restlessness.

From doctor to doctor. If the diagnosis of ASA is ever made, this only happens after an average of three to five years. Those affected usually go through an odyssey from doctor to doctor beforehand. The family doctor, who cannot find a physical cause (there isn't any), refers to a specialist. Since the patient often cannot find any help here either, he searches for other experts.

The patient is examined by one specialist doctor after another in the hope that a physical cause will finally be found. Again and again you get to hear: “You have nothing.” Resignation and disappointment about the doctors, who cannot find a physical explanation, spread. The hint that there might be a psychological cause is often not popular; after years of organic research it is difficult to imagine such a cause.

ASA patients often feel helpless. Because there is no tangible reason, no sick body part and no "reasonable illness" to which the pain could be ascribed. In addition, they sometimes have to put up with the suspicion that they are only simulating their suffering. The reason: With ASA there are no abnormal findings or deviating laboratory values, and the imaging (e.g. X-ray) does not show any abnormalities. Still, there is no doubt for professionals that the pain is real. “People with ASD have long periods of sick leave, frequent visits to the doctor and hospital stays. Somatoform disorders are a prime example of how important it is for doctors, psychologists and psychotherapists to work together, ”says Morschitzky.

Emotional conflicts. With ASA, psychological problems can both trigger and worsen the pain. Emotional conflicts and persistent heavy burdens are characteristic. Negative emotions are perceived as physical pain. One reason for this: The feeling of pain is located in the brain in an area that is also the seat of feelings. Social and physical stress-pain systems are closely linked on a neurobiological level. In long-term stressful situations, physical pain and negative emotions are activated. Often with ASD there are also traumatic experiences in childhood or years of stress in the sense of strong emotional stress.

Conventional pain relievers are usually ineffective. Antidepressants, on the other hand, have proven to be quite useful in some patients. They can help you distance yourself from the pain, and lead to better sleep and less tension.

In the treatment of ASA, the focus is on psychotherapy. Above all, it is important to deal with the underlying conflict or the ongoing stressful situation. The aim is also to change the perception of pain; to learn that negative feelings are often experienced as physical pain.

The patient can consciously control the degree of suffering. Fighting pain, rejecting it, or even consciously trying to block it out, makes the pain even worse. On the other hand, the attitude is helpful: I have pain, it is part of my life, but I can still lead a good life. Don't give up, but live actively and create an everyday life that, in addition to all activity, also offers space for retreat, rest and relaxation.

“It is not uncommon for people with ASD to have a personality structure with a strong will. Part of their life motto could be: My will be done. This way of life inevitably leads to states of tension that also manifest themselves physically. With this type of person, an increasing vicious circle begins over time, because he also meets the increasing physical tension and pain with the same attitude. So here too you want to get your way, reject the pain and with this posture further increase the internal tension. "

Symptoms subside. "Only when it is possible to recognize the usual evaluation program - my will be done and nothing else - and move away from it bit by bit, in the sense of letting go and letting things be as they are, the symptoms can subside - right up to complete freedom from symptoms, ”says Wolfgang Pichler, psychotherapist in Wels.

That was exactly the case with Romana B. After coming to terms with her stressful past and learning how to let go of it, she was finally able to receive help after 15 painful years. She has left the agonizing state and is free of pain again. "After just a few conversations, she managed to change some old beliefs and throw them overboard," says Pichler. “This has reduced her resistance to events in her life. As a result, their states of tension have diminished and finally dissolved completely. "

("Die Presse", print edition, January 12, 2014)