When Suzanne O'Sullivan, MD, was working as a neurologist at the Royal London Hospital in 2004, she was assigned to treat epilepsy patients who, inexplicably, just weren't getting better. Having run out of standard treatments, she suspected that maybe their pain didn't stem from a physical problem after all.O'Sullivan investigated and discovered that many of her patients were indeed suffering from psychosomatic disorders, with psychological stress manifesting as seizures and other bodily problems. That work eventually led to the publication of her new book, Is It All in Your Head? True Stories of Imaginary Illness. We asked her what everyone needs to know about these disorders.

Q: What are the most common symptoms of psychosomatic disorders?
A: Headaches, dizziness, memory loss, stomach pain, seizures—you name it. Psychosomatic conditions are defined by the fact that they can't be traced back to a medical problem like an injury, a disease, or a tumor. The important point, though, is that the symptoms are real.

Q: How do you diagnose such disorders?
A: I often base my diagnosis on signs that don't fit well with a disease but do fit well with a psychosomatic condition. For example, if I ask a psychosomatic patient who has tremors in his left hand to tap the table with his right, both hands will tend to shake at the same cadence. That won't happen with a patient who has tremors in one hand due to Parkinson's because that disease involves the breakdown and death of nerve cells in the brain.

Q: What's triggering the symptoms?
A: It could be as profound as dissociating from a childhood trauma, or it could be related to recent stress, like a job loss.

Q: And what's happening in the patient's brain?
A: When researchers have used functional MRI to scan the brains of people with psychosomatic paralysis, they've found that the area of the brain the patients are trying to recruit when they want to move isn't the same area that's regularly involved. It's as if they've trained their brain in a negative way. Once the patient is able to acknowledge that the problem is psychosomatic, we can work on training the brain to function normally again.

Q: Is a psychosomatic diagnosis hard for patients to accept?
A: It can come as a terrible shock. Some people think psychosomatic means "Oh, you're saying there's nothing wrong with me."

Q: Is the disorder related to hypochondria?
A: For people with hypochondria, the problem is more about their disproportionate anxiety over a symptom that's often quite small. Those with a psychosomatic condition may also be worried, but they're dealing with physical symptoms that are stopping them from functioning normally.

Q: What should family members do if they suspect the root of a loved one's problems is in their head?
A: It's ill-advised to suggest to your loved one that you think her problems are psychological until she herself is prepared to accept that. I recommend encouraging the person to see a doctor who specializes in whatever the physical symptoms are, like a cardiologist for heart palpitations or a neurologist for numbness or tremors, but is also open to treating psychosomatic disorders.

Q: Why is it so important to understand these disorders?
A: Because failing to understand them leads to unnecessary suffering. Change has to start with doctors. We're terrified we'll overlook a disease, but that fear can mean spending months searching for a physical cause without considering other possibilities. That's time the patient could have been getting the proper treatment, like psychological, occupational, or physical therapy. The sooner you make the correct diagnosis, the likelier the person will get better.

By the Numbers
$256 billion: Amount that treating people likely to have psychosomatic disorders (who often see many doctors) is estimated to cost the U.S. healthcare system annually.

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