Medically Unexplained Physical Symptoms and the Role of Anxiety

A warm welcome to Dr. Natalie Fleischacker, as a guest author.

What are medically unexplained symptoms?

It has been known for quite some time that stress/anxiety is not good for our physical wellbeing. However, with advancements in medical and psychological research we have found that anxiety can wreak more havoc than ever previously imagined. Medically Unexplained Physical Symptoms (M.U.S.) are just as they sound; physical symptoms for which there is no medical explanation. If you’ve had a few tummy aches that cannot be explained by bad sushi, or the occasional headache after a stressful day at work, don’t panic. The phenomenon of M.U.S. is reserved for those who experience persistent physical symptoms (e.g., dizziness, nausea, stomach cramps) that last weeks, even months, for which there is no medical cause. In many cases, the patient reports having different symptoms at different times, or multiple symptoms at once. Typically, individuals who experience M.U.S. consult with their primary care physician as well as specialists, and undergo several different medical tests. Unfortunately (or fortunately), the results of such tests are negative and the cause of the symptoms cannot be identified. Needless to say, this is an extremely frustrating process for the patient, which leads to more anxiety in and of itself.

What is the anatomy of anxiety?

To better understand the possible causes of M.U.S., we need to understand exactly what anxiety is and how it affects our body. Anxiety is a reaction to stress that can have both psychological and physical expressions. The amount of, and frequency with which, a person experiences anxiety determines the degree to which it affects you. We all encounter stressful situations such as a job interview or an important test. Situations such as these would cause anyone to feel a bit anxious. In fact, low levels of anxiety can even be helpful. For instance, a little worry may motivate you to prepare for that upcoming job interview. However, when anxiety becomes excessive and impairs our daily functioning, then it becomes harmful to our physical and mental wellbeing. I will refer to these persistent, high levels of anxiety as pathological anxiety.

In response to stress and perceived danger, our bodies have a natural, physiological reaction called the ‘fight or flight response’. When we detect a threatening situation, our sympathetic nervous system (SNS) prepares our bodies to either fight off the threat or run from it. The SNS signals the adrenal glands to release stress hormones such as cortisol and adrenaline. These hormones cause a number of physiological changes such as increased blood pressure, suppression of the immune system, and changes in glucose levels. Our heart accelerates, digestion slows down, blood vessels constrict, and our muscle tension increases. In response to these changes, we can experience certain physical reactions such as difficulty swallowing, dizziness, dry mouth, headaches, and muscle aches to name a few.

How is anxiety related to M.U.S.?

Pathological anxiety can trigger the ‘fight or flight’ stress response on a regular basis. Depending on how severe one’s anxiety is, this stress response can be activated numerous times throughout a day. As the SNS continues to trigger physical reactions, it causes a wear-and-tear on the body. Eventually, the repeated activation of the nervous system and chronic release of stress hormones have serious long-term physical consequences, including:

• Suppression of the immune system
• Muscle tension
• Digestive disorders
• Short-term memory loss
• Premature coronary artery disease
• Heart attack

In many cases, M.U.S.’s are physiological reactions to pathological anxiety, constantly triggering the activation of the stress response. Since these symptoms are essentially the result of chronic anxiety and not an identifiable medical problem, they are challenging to treat. Additionally, any attempts to manage the pain associated with certain symptoms are undermined by the patient’s continued anxiety. For instance, a physician may prescribe Zofran for chronic nausea and stomach. However, the relief from this medication will be short-lived if the patient continues to be pathologically anxious.

It is important to note that while these physical consequences are a response to anxiety, anxiety alone is not the trigger. There are approximately 40 million adults in the U.S. who suffer from anxiety disorders, many of whom do not experience physical symptoms. Whether or not you become physically ill depends on how you cope with anxiety.

Are certain people more prone to anxiety?

The short answer is ‘yes’. However, there are many factors that play a role in the development of pathological anxiety, including biological, environment, and psycho-social factors. Research has shown that one of the strongest influences on the development of pathological anxiety are pre-disposition factors; namely the influence of personality. Personality traits reflect a person’s characteristic, habitual way of thinking, feeling, and behaving in the world. The single most significant personality trait associated with anxiety and depression is neuroticism. Neuroticism is a long-term tendency to be in a negative or anxious emotional state. These are the folks who walk through life with a black cloud over their heads. Theyare particularly sensitive to environmental stress and tend to interpret ordinary situations as threatening and minor frustrations as hopelessly difficult. Individuals with neuroticism tend to have more depressed moods and suffer from feelings of guilt, envy, anger, and anxiety more frequently and severely than others. Neuroticism has gained much attention among scientists over the years, and has been found to be predictive for numerous mental and physical disorders. Also, individuals with this type of personality structure are particularly vulnerable to the physiological effects of anxiety because of their impaired ability to cope with stress.

How can you treat medically unexplained physical symptoms?

As with many problems, the best place to start is at the root. In this case, treating the anxiety would be the best bet. As mentioned above, treating M.U.S.’s with a medical solution will only mask the problem, and most likely, offer temporary relieve at best. There are many treatment options for anxiety, including lifestyle changes (daily exercise, balanced diet), meditation, psychotherapy, and psychotropic medication. If you believe you may suffer from anxiety, start by talking to your primary care physician. You may be referred to a mental health specialist (e.g., psychologist, psychiatrist), who can determine what your specific treatment needs are and assist in developing a treatment regime.

photo credit: Official U.S. Navy Imagery Sailors assess a patient in the main battle dressing station during a mass casualty drill. via photopin (license)