The Significance of Somatic Symptoms

By: James P. Krehbiel

I recall a young man who contacted me for counseling services who was experiencing a wide array of somatic symptoms. Somatic symptoms represent psychological distress that manifests itself as bodily ailments. The person typically feels no psychic pain because the body acts as protective armor, immunizing the sufferer. Generally, physical pain is more easily tolerated than emotional trauma. Case in point is the self-cutter who prefers to experience the physical pain of slashing cuts on her body as opposed to accepting the reality of thwarted anger.

The young man mentioned above worked in a high stress social service occupation. During his three month period of becoming physically unglued, he had visited the hospital emergency room over a dozen times. Various medical tests were performed, including those related to his cardiovascular system, digestive functioning, and neurological processing. All tests, such as an EKG, stress test, an endoscope, and CT scan came back as normal. His heart palpitations, chest pain, stomach aches, and dizziness could not be explained through medical testing and assessment.

Several doctors suggested that his symptoms were somatic in nature (stress-related). They recommended that he seek professional counseling as a way of addressing his issues. My patient was perplexed because he was unable to recognize any psychological factors that would account for his bodily sensations and behavior. It is not unusual for those individuals involved in high stress jobs to learn coping mechanisms to inoculate themselves against the ravages of emotional trauma. People in these professions, such as police officers, paramedics, and correctional guards tend to react off of the adrenaline of the experience and bury their emotional state. That was the mode of operation for my brother during the Vietnam conflict. Survival and coping instincts transcended any emotional ramifications of events on the ground.

Unequivocally, one thing is true about emotional pain. If it is present, it may delay rearing its ugly head, but eventually it will find us. We may be able to protect ourselves for a period of time, but eventually the "red flags" will emerge and we will be forced to grapple with our emotional vulnerability. A colleague once said, "Avoid facing your neurosis as long as you can, because it will eventually make itself known."

Now was the time for my patient to face his issues. Our body will keep up its clamoring antics until we begin to pay attention to its warning signs. Unfortunately, some people are adept at ignoring their physical symptoms and pay a needless price through cardiovascular disease and other life-threatening ailments.

Fortunately, this was not the case with my patient. He courageously stepped forward and asked for help. The healing process associated with somatic symptoms begins with acknowledgment, recognition, and the expression of a willingness to change. The therapeutic goal is to reattribute the physical symptoms to a complex of psychological distress. That which manifests itself physically eventually becomes emotionally identifiable. This process of identification is not easy because it is more comfortable to hide behind the physical pain.

Behind the physical pain lies a wilderness of feelings consisting of fear, sadness, grief and loss, traumatic events, hurt and disappointment, anger, and the need to try to control life circumstances. Healing begins when these emotions are expressed and addressed. It is always good to make friends with our enemies, as we must learn to embrace the disowned aspects of our "self."

James P. Krehbiel, Ed.S., LPC is an author, freelance writer, and cognitive-behavioral therapist practicing in Scottsdale, Arizona. He can be reached at or

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