Maury Joseph, Psy. D.

Licensed Clinical Psychologist in Washington, DC

Specializing in Treatment-Resistant Conditions and

Medically Unexplained Physical Symptoms

About Dr. Joseph Contact Dr. Joseph

Syndromes and symptoms like Irritable Bowel Syndrome, migraine, and fibromyalgia are all-too-common among folks struggling with emotional difficulties. The emotional forces that drive these symptoms are often operating automatically, instantaneously, and totally out of awareness, which makes them difficult to diagnose, treat, and, more than anything, live with. Why does this happen? How are emotions and physical problems linked?

 

·Anxiety. Every physical structure of the body is linked to the emotional centers of our brain by the somatic and autonomic branches of the nervous system. If you have ever had any traumatic experience related to emotions, even one you do not remember, rising emotions may trigger an anxiety response in your body (Abbass, 2015). Anxiety can be conscious-- related to our thoughts and expectations, or unconscious-- related to feelings and reactions that are out of our immediate awareness. Here’ how it works:

a.       Every striated muscle you can tense voluntarily can be tensed involuntarily by conscious and unconscious anxiety, contributing to a variety of stiffness and pain from tension. Fibromyalgia and other pain conditions can be linked to this, and striated muscle tension from anxiety can interfere with recovery from injuries.

b.      The smooth muscles of your gut, veins, arteries, capillaries, bronchi, and urogenital systems can all be tensed in response to unconsciously-mobilized anxiety, contributing to IBS, migraines, hypertension, reactive airways (often diagnosed as asthma), and urges to urinate and defecate.

c.       Severely dysregulated anxiety can lead to changes in the flow of blood, oxygen, and neurohormones to important centers in your brain, contributing to pseudoneurological complaints such as difficulty thinking and focusing, dizziness, fainting, tingling or weakness in the extremities, and distortions of your senses (e.g., tunnel vision, blurry vision, hallucinations).

·Conversion. For some people, rather than being able to feel emotions as they are triggered in their body, they will experience motor weakness, numbness, or heaviness in limbs. This toss of tone, sensation, and motor power seems to be a way their bodies have learned to prevent feelings and the impulses attached to them from being fully felt and accepted, and is usually linked to emotional trauma in close relationships (Abbass, 2015).

·Somatization. Somatization might be easier to understand if we refer to it as “sympathy symptoms” (Abbass, 2016, personal communication). With sympathy symptoms, pain is the result of our sympathy with and love for the person or people we are angry or enraged with. Psychoanalysts call this identification with the object of rage (Frederickson, 2014). In somatization, when anger is triggered towards a loved person, usually at an unconscious level, any physical impulses attached to that anger are unconsciously deflected back onto the body. For instance, during therapy a person presenting with crushing chest pain may become aware of buried impulses to damage the chest of someone they love. In somatization, these impulses were turned back against the self, often as an unconscious self-punishment because of guilt about the impulses and love for the fantasied “victim”. In therapy for somatization, people are then helped to simply feel and accept these impulses without acting on them or somatizing them. This may sound like some “woo-woo” psychoanalytic theorizing, but the links between repressed anger and physical symptoms is becoming more and more accepted in mainstream pain medicine (see the work of John Sarno, e.g. Sarno, 2007).

If you have been suffering from physical symptoms, and medical tests have been inconclusive and somatic interventions have failed to relieve your suffering, consider scheduling a consultation with me. My training in ISTDP helps me work effectively with all 3 of these emotional forces. Using an emotion focused interview, we may be able to rapidly identify whether one of the aforementioned unconscious emotional processes is driving your symptoms, and then you can decide whether you want to work with me to overcome these harmful ways that your body has learned to deal with emotions. In the meantime, check out the budding research on ISTDP and medically unexplained physical symptoms:

Implementing an Emotion-Focused Consultation Service to Examine Medically Unexplained Symptoms in the Emergency Department

ISTDP to Reduce Rates of Emergency Department Visits for Patients with Medically Unexplained Symptoms

Short-Term Dynamic Therapy for Somatic Disorders

Somatization: Diagnosing it Sooner Through Emotion-Focused Interviewing

References

Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press

Frederickson, J. (2014). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves Press.

Sarno, J.E. (2007). The divided mind: the epidemic of mindbody disorders. New York, NY: Harper