How mental distress can cause physical pain

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anxiety, Depression, depressive symptoms, diagnosis, distress, emotional distress, emotions, gastrointestinal issues, mental health issues, nausea, numbness, palpitations, panic, panic attacks, physical aches, physical pain, physical symptoms, psychological symptoms, stomach pains, stress

How mental distress can cause physical pain

It took Gemma* years to realise why she vomiting three of four times a week. She wasn’t suffering from some mysterious stomach illness. Instead, it was her mental health deteriorating.

“I have generalised anxiety disorder and panic disorder. I actually had physical symptoms first, long before I even knew what panic attacks or anxiety were,” the 24-year-old student based in London tells The Independent. “I suffer particularly badly from gastrointestinal issues. I spent years throwing up three or four times a week, ending up in hospital, with no real discernible ‘physical’ cause. The cause was anxiety, expressed physically.”

Gemma believes that her condition went undiagnosed for so long because of how mental and physical conditions are too often treated as mutually exclusive, when they are in fact inextricably linked.

“I think people very much misunderstand the link between physical and mental health,” she goes on. “I was one of those people. I didn’t even realise they could be connected when I was a teenager. I thought I was relaxed. Anxiety was the last thing I thought I was suffering from. But I was ignoring a lot of stress and was poor at acknowledging my own emotions. That stress had to come out somewhere, and I almost feel like it was my body trying to get me to listen.”

Now, Gemma knows that anxiety can cause her severe stomach pains. Or that panic attacks are what most often fill her stomach with nausea, cause her arms and legs to go numb, and her heart to palpitate.

Similarly, Courtney*, a 25-year-old publicist based in London, says her depression causes her to feel lethargic and sluggish and her bones and joints stiff and achy.

“The bigger problem with physical symptoms is for the anxiety side of things. Outside of panic attacks, a bad flare up of anxiety gives me absolutely stunning headaches with blurred or double vision, which often makes it hard to work – especially at a computer screen,” she tellsThe Independent.

And as the stigma of suffering from mental illness is talked about more widely, these comparatively nuanced aspects of understanding health are what need to be tackled next, say experts.

“The idea that mental illness is ‘all in your head’ is not only outdated, but can make us blind to the physical symptoms that can be a sign of mental health problems,” Rethink Mental Illness spokeswoman Nia Charpentier tells The Independent.

“For example, if you have anxiety, you may experience a fast heart rate and sweating; or for someone living with Post Traumatic Stress Disorder, the flashbacks can cause aches and pains, or make you feel sick. Similarly, depression can affect your appetite, causing you to either lose or gain weight.

Eating disorders such as bulimia and anorexia are perhaps the most obvious ways that serious mental illness can affect a person’s physical health.

“In the case of eating disorders, these illnesses may well involve physical symptoms that can become increasingly obvious over time, depending on the specific illness. However, it’s very important to remember that these are mental illnesses at their root, and changes to behaviour and mood will probably be noticeable long before any physical signs,” a spokesperson for the eating disorder charity B-Eat stresses. “It’s vital that people are aware of these psychological symptoms as well as the physical ones, as the sooner someone enters treatment for an eating disorder, the better their chance of recovery.”

It is erasing this confusing that spurs the Mental Health Foundation on to campaign for health check to include mental health screenings.

“Men in their forties are routinely screened for their blood pressure and cholesterol levels, when they are more at risk of ending their life by suicide,” points out Dr Antonis Kousoulis at the Mental Health Foundation, adding: “It’s crucial that health screening cover the health of our minds as well as the health of our bodies.”

*Name has been changed

Explaining tokophobia, the phobia of pregnancy and childbirth

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anxiety, birth, childbirth, distress, fear, hyperarousal, labour, media, negative birth experience, panic, positive birth experience, post-birth PTSD, pregnancy, PTSD, social media, symptoms, tokophobia, trauma, treatment

Explaining tokophobia, the phobia of pregnancy and childbirth

For expectant mothers, it’s very normal to approach birth with a feeling of trepidation, particularly for the first baby. From the moment a pregnancy is announced, the average pregnant woman is inundated with horror stories of pain and long labours by supposed well-meaning friends, and it can be hard to focus on a positive birth experience when you don’t know what to expect.

But for some women, the fear of childbirth goes beyond trepidation into full-blown anxiety, panic and fear. Known as tokophobia, this phobia of childbirth affects somewhere between 3-8 per cent of pregnant women.

Symptoms include worries specifically about the pregnancy and birth, a fear of harm or death related to the birth, poor sleep, and a sense of hyper-arousal (rapid heartbeat and breathing, difficulty winding down). The fear of childbirth is a common non-medical reason for requesting a caesarean section, and women with this fear have a much higher rate of both caesarean delivery and use of epidural anaesthesia.

There is no clear path to developing fear of childbirth, but there are some risk factors that we know about. A history of anxiety or depression is one risk factor, as is a history of childhood abuse, be it sexual, physical or emotional abuse.

Some studies have also identified patterns with age, suggesting younger mums are more vulnerable, as are those with less education, and mums without a strong social network.

However, a recent study found that one of the biggest influences women reported on their fear of childbirth was the media. Hospital-based reality television programs and medical dramas often feature storylines with dramatic emergency situations during childbirth and this may be all women know of giving birth prior to the event.

We also know that around 95 per cent of pregnant European women report searching for pregnancy and birth information online, and social media and blogs hold the potential for the circulation of misinformation that may heighten fears rather than allay them.

There is another group of women who may find pregnancy and childbirth frightening due to related fears. One of the most common phobias in adults is blood/injury phobia, often including a fear of injections. Pregnancy and childbirth is hence very confronting for these women, who may faint or experience extreme distress at even routine blood tests throughout their pregnancy.

Researchers have found that for first time mothers, a positive birth experience can often relieve the fear of childbirth so that it is no longer an issue for future pregnancies. However, whether or not women start with a fear of childbirth, a negative birth experience can make them up to five times more likely to develop tokophobia for future pregnancies.

A negative experience of birth may be due to complications, feeling out of control, dissatisfaction with care providers, or just not having the birth that was expected. Between 2-6 per cent of women report post-traumatic stress syndrome (PTSD) following a difficult birth experience. PTSD is the disorder once known as ‘shell shock’ for its affliction of soldiers following war, and is characterised by nightmares and re-experiencing of the birth trauma, avoidance of all reminders of the birth, and hyper-arousal. Without treatment, PTSD can limit family size and cause problems in women’s relationships with their partner and their child.

While we may not hear much about tokophobia and post-birth PTSD, their prevalence suggests we do need to look out for women who may be suffering both before and after birth. In addition to the distress at the time, stress and anxiety during pregnancy are linked to a higher rate of preterm birth and later behavioural problems in children.

The good news is that like all anxiety disorders, the fear of childbirth and PTSD can be addressed and treatments are available. One of the most vital elements of treatment is education on birth, whether through the obstetric care provider, midwives, or antenatal classes. Knowing what to expect and having an agreed plan with your care provider can assist to overcome some of the irrational fears.

Linked to this, a supportive and trusting relationship with the care providers who will manage the birth is essential. This is not always possible as some obstetric settings do not allow for repeated contact with the same provider, but a relationship of trust will be more likely to create a positive birth experience.

When problems do occur in pregnancy and birth, a post-birth debriefing can be useful and may help prevent the development of PTSD symptoms. Understanding what went wrong and why things happened the way they did can help with processing the events and accompanying trauma.

As with other anxiety disorders, relaxation, light exercise and slow breathing can help to calm the body and relieve the hyper-arousal that comes with the fear of childbirth. A psychologist can assist with other anxiety management techniques that can help to minimise fears.

For those who find the idea of pregnancy and birth overwhelming, it is important to know that help is available and such symptoms can be successfully treated. The first step is confiding your fears so that those around you can start to support you through what could be a wonderful journey.

Night terrors: In my wildest dreams

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adults, Children, night terror, nightmares, panic, reassurance, scream, shout, sleep, stress, terror

Night terrors: In my wildest dreams

The walls are closing in on me. The air is sucked out of my lungs and everything turns black. One thought pulses through my mind – to get out of the room, no matter how. I push open my window and start climbing out. Only when the fresh air hits me do I realise something’s not right. I fall backwards and crawl back into bed, confused and disorientated by my surroundings.

This was the most dangerous night terror I suffered during my final year at university. I initially forgot what had happened, until I saw the chaos the next morning – my desk and chair were overturned, my books had been knocked off my bedside table and my laptop’s screen had smashed. The window was still wide open.

Deep bruises came up a day after, with the right-hand side of my body turning black and blue. My GP practically laughed me out of the surgery when I went in for a consultation. “There’s nothing I can do about it, it happens in your sleep,” he said, smiling. It was only once I had moved to London and suffered a similar attack that left me bleeding that I decided I’d had enough. After a three-month wait, I finally managed to get a space in one of the UK’s busiest sleep clinics for an overnight study.

The technicians wired me up at the clinic at London Bridge. There were 10 sensors attached to my head alone, with countless cables running down my body. Lying on the bed, monitored by two cameras, I knew that I wouldn’t be having a night terror that night. But I was hopeful that the results might shed some light on my condition.

When someone suffers from a night terror, they can scream, shout and thrash around in extreme panic, sometimes jumping out of bed. It’s an unnerving experience for anyone to watch – the sufferer’s eyes will be open, but they’re not fully awake or aware of what they’re doing. Once the panic subsides, the person will fall back asleep, oblivious to the chaos.

Most people experience nightmares or night terrors growing up. Figures show that between 20 and 30 per cent of children between the ages of five and 12 have frequent nightmares, while night terrors affect 17 per cent of children. Once children reach adulthood, incidence rates are much lower, with only one in 20 of that 17 per cent still reporting night terrors in later life. But recent research has linked recurring night-time problems to more ominous long-term consequences. A study conducted by the University of Warwick followed nearly 6,800 children up to the age of 12. The results suggest that long-term sufferers of nightmares and night terrors have a higher risk of mental health problems as they enter adolescence. Those having nightmares aged 12 were three-and-a-half times more likely to have problems and the risk was nearly doubled by regular night terrors.

Psychology professor Dieter Wolke led the research at Warwick. He says that while children often experience night-time problems, in adults, it’s only around 1 to 2 per cent who still have night terrors. When they persist into adulthood, the physical risks also increase. “Night terrors become more dangerous, as you’re larger and more mobile. People are known to have fallen off balconies or thrown themselves out of windows,” says Professor Wolke.

From a young age, I have been a restless sleeper, but the night terrors only started happening when I entered my teens. It wasn’t until university that they became more severe. The more extreme ones saw me running around the house or frantically trying to open my bedroom window.

So why do night terrors occur? According to Dr Nicholas Oscroft, a respiratory physician at Papworth Hospital, genetics and not getting enough sleep could be to blame. “It does seem to run in families… From previous research it has become clear that night terrors happen more often if people don’t get enough sleep on a regular basis. Work or family-related stress also increases the risk.”

Another sufferer is 24-year-old Kevin Stone. He started having night terrors from the age of seven. He believes it’s because of having lived in South Africa, where his family experienced regular break-ins. His night terrors follow a repeated theme – someone is always trying to chase or kill him. “I once dreamt that people had broken into the house and were in my room. They made me get out of bed and kneel on the floor while I tried to convince them not to kill me. When I have a night terror, I act out everything. I can hear their voices, I can see them, I can even feel the gun against my head.”

Stone’s night terrors took a gruesome turn when he was 18. One night, he woke up and was convinced someone had broken into the house. As a result, he jumped out of his bedroom window and fractured his spine and broke both his ankles. “I realised what I was doing just before I hit the ground.” Terrified by what his sleeping mind was capable of, he sought treatment to stop his night terrors from happening. But he believes that his problems can’t be solved, because it’s all in his mind. “Doctors have said to keep a bedtime journal to clear my mind, but that hasn’t worked.” He also wasn’t happy with the option of being prescribed antidepressants.

So can night terrors be solved? Dr Oscroft seems unsure. “Adult patients who suffer from them need to try and reduce how often it happens. The best way to achieve this is by getting enough sleep. People should also optimise their sleeping environment, so that they won’t be woken up during the first two hours of sleep, which is when night terrors are most likely to occur.”

Night terrors can put a strain on relationships. Dr Oscroft says the best thing to do when someone is suffering from a night terror is to reassure them. “People who are having a night terror will be agitated, so the best thing to do is to calmly talk to them until they wake up. Don’t try to restrain them unless they are in danger of hurting themselves.”

My results from the sleep clinic proved surprising. I had woken up four times during the night – flustered and disorientated. Even though there was no physical cause, I do suffer from slow wave arousal disorder, which is usually associated with sleepwalking and other sleeping disorders. Aside from the advice to sleep more or to take sleeping pills, my diagnosis remains unchanged. I suspect that it will be something I’ll have to deal with on a regular basis throughout my life. Until they stop completely, I’ll be keeping my bedroom window firmly locked.