“Is It All In My Head? Stress, Anxiety, and the Body’s Somatic Response”
If you were drawn to reading this blog, it may be because the scene is familiar. You experience one or more uncomfortable health symptoms. Uncomfortable digestive issues, sudden body aches, a skin issue that won’t go away, or maybe just the feeling that something is off. So you go to the doctor and a bunch of tests are ordered. The results come back with some blood level off – either very mildly or very severely – or maybe everything comes back normal. Maybe the doctor says they can’t pinpoint a cause; that they can only help manage symptoms. They may seem dismissive or vague about the plan of action. They imply you should feel relieved that it’s not something serious, but instead you are confused as to why the tests aren’t showing how bad you feel. Your mind is already reeling with a host of different thoughts and emotions …. And then the doctor asks:
“How are your stress levels?” or says….
“Maybe you should talk to a counselor” or the dreaded….
“This might be anxiety.”
You feel dismissed, confused, and like you are being blamed. Though very few doctors these days will say “It’s all in your head” (some of them used to), that may be exactly what you hear. You may feel like you’re being blamed – that they’re saying you can somehow think your way out of the situation. You may start to question the very real experiences that led you to make an appointment. Maybe it makes you feel shame or embarrassment, and maybe you think twice next time you need a doctor’s help.
It’s All In Your Head?
A doctor’s personality, training, and bedside manner may lead them to describe what is happening in a way that feels far from helpful, but they are likely referring to is the way that additional stress activates the Immuno-Psychological-Endocrine-Gastrointestinal (IPEG) Response and how this process may be causing or exacerbating your symptoms. Practically speaking, the impact of the IPEG Response is not always seen in the objective tools medical professionals use to diagnose symptoms – imaging, visual exams, and blood tests. They may also not be improved using the tools medical professionals use to treat symptoms – medications and surgical interventions. Suggesting that a patient attends to mental/emotional stressors is an admission that their medical training has limits and that other interventions may help to lessen the impact or frequency of your distress.
The following is an explanation of how the IPEG Response works and ways it can impact the body, how to advocate with medical professionals, and what psychotherapy can do to help.
The IPEG Response
Homo sapiens (the Latin name for modern humans) evolved in our present form about 300,000 years ago. Our lifestyles changed very rapidly 12,000 years ago with the agricultural revolution, even further about 150 years ago with the industrial revolution, and again a few decades ago with the information revolution. However, that has not given our brains and bodies much time to evolve. Thus, our brains and bodies are still hardwired according to the needs of our ancestors – small groups of nomads who hunted and foraged for food. Encountering danger activated the system that linked our nervous system to our endocrine system, the hypothalamic-pituitary-adrenal or HPA axis, causing a group of physiological responses meant to increase our chances of survival. These included changes to how fast and where our blood flowed, how oxygen and sugars were utilized, and which muscles and nerve responses were given priority. Our gastrointestinal systems slowed down, and our immune systems geared up to protect us in the event we were injured. When the threat was over, our bodies reverted to the baseline state, with adequate time to rest and replenish in preparation for the next threat.
Long Term Impacts
These days, very few of us have to fight actual tigers, but we live in a world where other actual and perceived threats are nearly constant, and our HPA axis continues to act the way it always has. Loud noises, bright lights, cars racing by, texts from impatient bosses, a call from a bill collector, or the latest news headline dinging on our cellphone trigger the IPEG response at various levels throughout the day. Add these individual events to ongoing systemic/global threats like destruction of the environment, the threat of violence, mistrust of the government, economic pressures, and the impacts of racism, sexism, and other prejudices, and the IPEG response – designed to help us during acute threats – may be running nearly all the time. Our bodies never get a chance to go back to a fully resting state, and over time, the constant changes in physiology may make our systems more sensitive or start to become the default state. Many symptoms and diseases can be caused or exacerbated by chronic stressors, but some of the most common impact our metabolic, cardiovascular, nervous, gastrointestinal, and immune systems both in the short and long term. Some of these impacts can be seen in standard medical tests but often only once they’ve reached a certain point. For example, an overreactive immune or allergic response may cause distressing symptoms long before blood levels associated with an autoimmune disease, a condition in which a chronically heightened immune response attacks healthy tissue, are present.
Talking to Your Doctor
If we’ve had one or more interactions with a medical provider such as the one described above, it is easy to start wanting to avoid going to the doctor altogether. But even though many symptoms can be caused or exacerbated by stress, it is important to have a thorough medical evaluation to determine what, if any, diagnoses do or don’t exist and get a medical perspective on what treatment options are available. And in the event that the symptoms are so distressing that they feel dangerous, it is important to seek emergency services.
Once you have had a thorough medical evaluation, you may still feel you have a diagnosable condition and are simply being dismissed, the following are useful phrases that will help you advocate for ourselves and your loved ones:
“What is your differential diagnosis? What else could this be besides what you are suggesting?”
“If you had a loved one experiencing these symptoms, what would your next steps be?”
“If my symptoms do not improve or get worse, at what point should I come back for re-evaluation?”
“I understand that you feel this is not an organic condition, but I am still very concerned. Could you please record in my chart that I requested this test/referral/treatment and that you refused?”
And remember that you always have the right to request a second opinion.
Psychotherapy Can Still Help
Regardless of whether you have a diagnosable disease, attending to your mental health is likely to help. Stressors in your life can set off IPEG responses that may cause or exacerbate symptoms. Additionally, chronic pain and discomfort can cause a phenomenon called central sensitization where the brain gets trained to interpret very mild symptoms as subjectively more intense. This perceived intensity can cause even further IPEG activation, creating a cycle that is very difficult to break without an expert's assistance.
All pain is subjective, and regardless of whether your symptoms can be seen or diagnosed by a medical professional, you deserve to have them addressed if they impact your quality of life. This is where a psychotherapist with proper training and experience can be helpful in helping you cope with symptoms, address the IPEG response, or navigate the treatment process.
Your mental health treatment can take many forms, depending on your individual symptoms and how they are impacting you, but it is important to find a provider who understands the impacts of stress on your physical health and has adequate tools to address it. Talk therapies such as cognitive behavioral therapy or psychodynamic therapy can be helpful but are rarely effective on their own. Providers who have some training related to traumatic stress, the mind/body connection, and somatic therapies often have approaches that can interrupt, lessen, and prevent your physical responses to stress. It is also important that your provider is able and willing to help you identify how ableism may be impacting your ability to thrive. They should also have tools to help you advocate for yourself with regard to any treatments and accommodations that would increase your quality of life.
So next time you have a physical symptom, make sure that you get a thorough medical evaluation and follow whatever treatments your doctor prescribes. But you can also feel some relief that if your medical provider suggests that stress or anxiety may be in play, it is not necessarily a dismissal of your symptoms. Instead you can view it as a way of conceptualizing how your emotional and mental state may be contributing to your distress and give you vital information about how to increase your quality of life, regardless of what happens next.
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Our modern life is full of stressors, both interpersonal and systemic, that can have detrimental impacts on our physical health and even lead to certain medical diagnoses. Dr. “E” Elisa Curl-Woodruff (she/they) has extensive experience working with clients who live with chronic medical concerns, chronic pain, and the physical impacts of stress. Dr. Curl-Woodruff has attended specialized training in both chronic pain and chronic gastrointestinal disorders. They also hold certificates in Neuropsychotherapy (education and intervention related to the brain’s role in specific mental health experiences), EMDR (Eye Movement Desensitization and Reprocessing), the Assessment and Treatment of Attention Deficit Disorder, and Insomnia. They take time to understand the causes of clients’ physical symptoms and work with their medical teams to attend to each according to individual preferences and needs.
Dr. Curl-Woodruff is currently taking new clients. Call 630-297-7559 to set up an appointment!
