What is Psychosomatic Illness and How To Cope

People with psychosomatic illnesses are often accused of faking it or making it up. This happens because they experience real physical symptoms such as chronic pain, stomach troubles, seizures, or breathing problems, but medical tests usually show no obvious cause.

This clean bill of health despite obvious illness raises an important question: how are the mind and body connected, and why can stress or emotions trigger real physical symptoms?

In this article, we will learn about psychosomatic illnesses, common symptoms, triggers, and diagnosis, and even lifestyle changes that could alleviate these illnesses.

What Is a Psychosomatic Illness

A psychosomatic (‘psycho’ meaning mind and ‘somatic’ meaning body) illness is a physical ailment of the body due to mental influences on the physiological state of the body. It is often triggered and sustained by chronic stress, anxiety, or other mental states, which can alter normal physiological functions and lead to genuine physical symptoms, known as psychosomatic manifestations. In psychosomatic or somatic symptom-related conditions, symptoms may or may not be explained by a medical condition; the diagnosis focuses on the distress and behaviors about the symptoms.

The cause of psychosomatic disorders is unknown; however, many factors, such as genetic, social, environmental, and biological factors, play an important role. The neurobiological pathway of psychosomatic illness often involves the hypothalamic pituitary adrenal axis (HPA axis), endocrine, and immune systems. Chronic mental stress impacts the entire system by acting as a stimulator for the activation of these pathways, which can lead to dysregulation and subsequent physiological distress..

The Mind-Body Connection Explained

A 2024 cross-sectional study on the Rates and Factors Associated with Psychosomatic Syndromes examined how common psychosomatic syndromes are amongst 6,647 patients data. In this study, complete cases across chronic medical conditions such as fibromyalgia, irritable bowel syndrome (IBS), migraine, coronary heart disease (CHD), and type 2 diabetes (T2D) were utilized. Using the Diagnostic Criteria for Psychosomatic Research (DCPR), along with standardized tools for anxiety, depression, stress, and well-being, the researchers found that alexithymia (difficulty in identifying and expressing emotions) was the most prevalent psychosomatic syndrome (about 64.5%).

Patients with IBS followed with a psychosomatic syndrome prevalence of 20.6% and demoralization 15.6% followed by irritable mood (20.6%) and demoralization (15.6%). Notably, nearly half of fibromyalgia patients experienced demoralization, highlighting the psychological vulnerability within this group.

Psychosocial factors strongly linked to multiple psychosomatic diagnoses included higher anxiety levels, abnormal illness behavior, poor overall well-being, and stress. These associations were particularly pronounced in fibromyalgia and type 2 diabetes patients. Overall, patients with fibromyalgia, IBS, and migraine were more likely to present with psychosomatic syndromes than those with CHD or T2D.

The results of this study highlight that the relationship between our mental state and our physical health is biological, measurable, and essential. The mind and body are intertwined, especially in the context of chronic conditions, immune responses, and overall well-being.

Common Symptoms of Psychosomatic Disorders

The most common features of psychosomatic illness include physical complaints (somatic symptoms) often accompanied by anxiety and depression. In fact, comorbidity with anxiety and/or depression is common in somatic symptom disorder but varies widely based on the setting. That said, some populations reporting 34% with somatic symptom disorder experience both depressive and anxiety symptoms concurrently.

Stress-related conditions and some complex medical conditions like hypertension, respiratory issues like shortness of breath, digestive issues such as IBS, chest pain, increased blood pressure, abdominal pain, sexual dysfunction, skin conditions like eczema, peptic ulcers, chronic fatigue, coronary heart disease, increased susceptibility to infections, and sleep disturbances, including insomnia may be influenced by psychosocial factors.

Psychosomatic symptoms rarely resolve on their own without addressing the underlying causes. Identifying these health problems is the first step towards restoring balance and homeostasis in the body. Additionally, people suffering from Psychosomatic symptoms hardly identify the emotional aspects of their condition, which is why a health professional is often needed to bridge that gap.

Identifying Triggers of Psychosomatic Responses

Sometimes, for psychosomatic illnesses to manifest, a multifactorial model is needed to trigger a response. For instance, it has been postulated that for a psychological disorder to develop, it might require the interplay factors such as genetic vulnerability and an environmental or psychological trigger. The most common psychosomatic triggers include:

• Traumatic events: Individuals react differently to stressful life events. While some develop resilience, others might develop post-traumatic stress disorder (PTSD). Somatic symptom disorder is more likely among individuals with PTSD. Unfortunately, individuals in this category may fail to recognize how their emotional state is contributing to the physical ailments they are experiencing.
• Personality traits: The variability in personality traits is an important aspect of psychosomatic medicine. For instance, individuals with alexithymia personality traits have an increased risk of developing psychiatric disorders. Additionally, impairment in personality traits (such as high neuroticism, low agreeableness, low consciousness, low openness, and low extraversion) can also impact coping strategies, emotion regulation, and stress.
• Genetic factors: Genetic contribution varies by disorder (30-50% for depression/anxiety; 60-80% for bipolar/schizophrenia Ris reflects many common variants of small effect plus environment.
• Environmental factors: Environmental factors such as stress, trauma, and exposure to toxins can induce epigenetic changes, which may disrupt stress response, immune function, or hormonal imbalance, and inadvertently act as a trigger or amplifier of psychosomatic diseases.
• Biological factors: The gut-brain axis establishes a two-way communication between gut microbes and the brain. A balanced microbiota improves mental states, while dysbiosis can lead to irritable bowel syndrome and can influence risk of depression, anxiety, and mood disorders.

These triggers are neither rare nor novel and can arise from different circumstances in life. Understanding some of these psychosomatic triggers can help physicians and psychiatrists develop personalized medical approaches that will suit each individual and help to maximize therapy outcomes.

Psychological Theories Behind Psychosomatic Illness

The impact of psychosomatic illnesses is relevant because it highlights the complex bidirectional relationship between the mind and the body, where mental health can influence physical ailments and vice versa. This complexity has led to the development of various psychological theories that explain how emotional and cognitive processes manifest as physical symptoms.

While earlier theories, influenced by Sigmund Freud, focused on psychoanalytic explanations, newer models combine biological, psychological, and social factors to provide a more comprehensive understanding. Some of the theories include:

• • Psychodynamic and Psychoanalytic Theory: This theory is rooted in the work of Sigmund Freud, who proposed that unresolved emotional conflicts or repressed experiences may be expressed through physical symptoms rather than conscious awareness. According to this view, when we suppress distressing emotions such as guilt, anger, or fear, the unresolved tension finds somatic expression. Although the original Freudian theory of symbolic symptoms is less emphasized in modern psychosomatic medicine, recent studies continue to associate emotional suppression with stress-related physical disorders. 
  • Stress-Related Theories: This theory describes how chronic psychological stress disrupts normal psychological health. In an article published in Jama Internal Medicine journal, the concept of allostatic load was used to explain the prolonged activation of the hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system due to chronic stress. Prolonged activation of these systems overwhelms multiple organ systems, and is associated with cardiometabolic predisposing an individual to disorders like hypertension, peptic ulcers, and irritable bowel syndrome.

• • Neurobiological and Cognitive Theories: More recent neurobiological theories highlight the direct pathways between the brain and the body. A good example is the vagus nerve that connects the brain’s emotional centers with vital organs such as the heart, lungs, and gut. Another 2025 article by Zuhal Koc Apaydin, on Somatosensory Amplification, brings new insights into how individuals who are hyper-attentive to internal sensations are more likely to misinterpret them as signs of illness, leading to a cycle of anxiety and physical distress.

In conclusion, the biopsychosocial model properly integrates all three perspectives, recognizing that psychosomatic illnesses emerge from interactions between our biological vulnerability, psychological processes, and social factors. In other words, factors like genetic predisposition, coping style, emotional regulation, and even social support all determine how psychological stress translates into physical symptoms.

Diagnostic Criteria for Psychosomatic Disorders

The diagnosis of psychosomatic disorders relies on a combination of approaches rather than one single or universal criterion. A medical professional first rules out other possible medical conditions through diagnostic tests before assessing the severity of psychological factors affecting the physical symptoms. Psychosomatic disorders are diagnosed when psychological factors significantly contribute to the onset, progression, or persistence of physical symptoms contributing to excessive thoughts, feelings, or behaviors about symptoms whether or not a medical condition is present.

Two important diagnostic frameworks relevant to psychosomatic conditions are the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Diagnostic Criteria for Psychosomatic Research (DCPR).

Psychosomatic disorders are classified under Somatic Symptoms and Related Disorders (SSRDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In previous editions of the Diagnostic and Statistical Manual of Mental Disorders (particularly the DSM-IV), the diagnosis of somatic symptom disorder did not yet exist and it was called a somatoform disorder which could not be made unless symptoms were medically unexplained. However, modern research and diagnostic systems no longer focus solely on the absence of physical diseases but on the relationship between psychological distress and somatic experience.

According to the DSM-5, to meet diagnostic criteria, three major components must be present: more than one somatic symptoms, excessive thoughts, feelings, or behaviors that are related to the symptoms, and persistent duration (this means that the somatic symptoms are persistent, typically lasting for more than six months).

Unlike the DSM-5, which mainly classifies mental health disorders, the DCPR (Diagnostic Criteria for Psychosomatic Research) is a revised system with modules for stress, illness behavior, psychological manifestations, and personality. In simple terms, the DCPR is a set of 14 psychosomatic syndromes, and is used alongside the DSM-5 to characterize psychosomatic syndromes.

Therapeutic Approaches for Managing Psychosomatic Symptoms

The management of psychosomatic symptoms requires a multidimensional approach that addresses both the psychological and physical aspects of the disorder. Modern treatment frameworks integrate cognitive behavioural therapy, stress management techniques, pharmacological treatments, and lifestyle interventions.

• Cognitive behavioral therapy (CBT): These techniques help to identify and modify negative thoughts that contribute to physical symptoms. CBT is a recommended, first-line psychotherapy treatment for SSD.

• Pharmacological Treatment: Treatments like antidepressants and anti-anxiety medications may be used when symptoms are severe or are linked to comorbid psychiatric conditions.

• Stress Management and Relaxing Techniques: Because chronic stress can worsen psychosomatic symptoms, stress management is a very important part of treatment. Mindfulness meditation and yoga may help to lower perceived stress and some physiological markers. Progressive muscle relaxation and biofeedback can help to modulate autonomic responses.

Integrating medical management, psychological therapy, and safe social support ensures that both the physical illness and the emotional suffering are addressed. Multidisciplinary interventions emphasize collaboration between physicians, psychiatrists, psychologists, and other allied health professionals to ensure holistic care.

Lifestyle Changes to Alleviate Psychosomatic Symptoms

Lifestyle modifications are usually an adjunct therapy in the management of many chronic illnesses, and for psychosomatic disorders, the body can benefit through the following lifestyle changes:

• Regular physical exercise.
• Quality sleep (7-8 hrs for adults).
• Healthy eating habits.
• Cultivating self-compassion.
• Strengthening healthy social support.
• Avoiding harmful substances like alcohol and tobacco;

These lifestyle changes are most effective when practiced together as part of a holistic approach to managing psychosomatic symptoms. Focusing on one area while neglecting another can undermine progress. For instance, exercising regularly without proper nutrition can actually place additional stress on the body, rather than relieving it. In other words, it doesn’t work well to selectively adopt healthy habits; they work in sync to support both mind and body.

The Importance of Professional Mental Health Support

A 2023 pilot study on Cognitive Behavioural Group Treatment examined the utility of brief CBT group intervention for individuals with SSD. When comparing pre- and post-group results, there were reductions in average scores for somatic symptom severity, depression, anxiety, stress, and pain-related disability. The authors concluded that, even though more research is needed, especially with a larger sample size, the study provides preliminary support for the potential effectiveness of CBT in reducing somatic symptoms, depression, anxiety, and stress in individuals with SSD.

Mental health professionals can help patients bridge the gap between their physical symptoms and underlying emotional or psychological causes. They guide patients through therapies and help to replace maladaptive coping mechanisms with healthier strategies that build emotional resilience.

Preventative Measures and Long-term Coping Strategies

Self-awareness allows us to recognize early signs of stress triggers and emotional distress can prevent these factors from manifesting as physical symptoms. This starts by building resilience through working on self-awareness, consistent self-care, emotional awareness, and developing and maintaining healthy coping mechanisms.

Healthy coping strategies like problem solving, seeking support, cognitive reappraisal, and gaining a sense of control over life events have been found to reduce psychological distress. These habits also help you develop positive self-esteem, improve resilience, and return to normal social functioning and routine activities.

So if you experience any emotional distress or chronic stress, don’t forget to reach out for help and practice healthy lifestyle habits and coping mechanisms.

Because psychosomatic symptoms are deeply influenced by stress and the body’s ability to rest and recover, quality sleep becomes one of the most powerful natural regulators of both mental and physical health. Restorative sleep helps balance the nervous system, reduce stress hormone levels, and strengthen emotional resilience—key factors in easing psychosomatic distress and promoting overall well-being.

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Frequently Asked Questions

What is the difference between a hypochondriac and a psychosomatic person?

While a hypochondriac constantly worries about having an illness despite little or no medical evidence, a psychosomatic person actually experiences real physical symptoms that are triggered or worsened by psychological factors like stress or anxiety.A medical diagnosis may or may not also be present.

How do you know if an illness is psychosomatic?

You might suspect an illness has a psychosomatic component when symptoms cause significant distress and often worsens with stress, anxiety, or emotional distress. A diagnosis focuses on excessive thoughts, feelings, and/or behaviors about symptoms with or without a medical explanation.

Which emotion is at the root of most psychosomatic disorders?

There is no single emotion most often at the root of psychosomatic disorders. Stress and anxiety are common contributors but not the primary cause. Psychosomatic conditions are multifactorial, meaning a result of usually biological, psychological, and social components.

Can your brain create symptoms?

Yes. Your brain can create symptoms through powerful mind-body pathways. The brain can trigger real physical sensations like pain, nausea, fatigue, or shortness of breath even without underlying diseases. These symptoms aren’t imagined; they are genuine bodily responses driven by psychological or emotional states.

Is IBS a psychosomatic disorder?

More accurately, IBS is considered a Disorder of Gut-Brain Interaction (DGBI); however, psychological factors like stress can trigger and worsen its physical symptoms.

REFERENCES

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Study of Rates and Factors Associated to Psychosomatic Syndromes Assessed Using the Diagnostic Criteria for Psychosomatic Research across Different Clinical Settings

Your disease is not real

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Psychosomatic health status and corresponding comorbid network analysis of college students in traditional Chinese medicine schools

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Psychotherapists’ views on triggering factors for psychological disorders

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A Modified Version of the Transactional Stress Concept According to Lazarus and Folkman Was Confirmed in a Psychosomatic Inpatient Sample

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