About two weeks ago, I had a patient present to me. He reported, ‘Doctor, I have a terrible headache, extreme dizziness, and a feeling of heaviness. I feel light-headed and weak. I need a thorough examination.‘ When I asked how long he had been experiencing this, he said, ‘About a week or ten days.‘ I agreed to the examination.
Upon evaluation, and considering the lack of objective physical findings, I suggested that his symptoms might be due to general tension or stress. The patient, however, did not accept this explanation.
He insisted, ‘Doctor, I want a CT scan or an MRI.‘ When I inquired why he was so keen on immediate advanced imaging, he stated, ‘No, Doctor, I feel certain I have a brain tumor. This must be a brain tumor. Please perform the test so I can be absolutely sure. I wouldn’t have this shaking, dizziness, and sudden jolting sensation otherwise.‘ I attempted to convince them otherwise, but was unsuccessful. We proceeded with the CT and MRI, both of which returned normal. Upon receiving the normal results, the patient was extremely relieved and happy, saying, ‘Ah, there is no tumor in my brain after all.‘
Case Examples of Somatic Complaints
I have many similar cases.
Case 2: The Cardiac Worrier
Another patient presented with the primary complaint of difficulty breathing, palpitations, and anxiety. Reviewing their medical files, I noted he had consulted multiple cardiologists and undergone numerous, excessive tests—ECGs and echocardiograms. When questioned about the extensive and repeated investigations, the patient explained, ‘Every time I experience a palpitation and chest pain, I immediately think I am having a heart attack and that I will die. This feeling compels me to rush to a private clinic or a specialized hospital like Gangalal (a known cardiac center).‘ He disclosed that in the past year alone, he had undergone approximately 10 to 12 echocardiograms, countless ECGs, and stress tests (TMTs).
‘Every time, the doctors send me away saying there is nothing wrong,‘ he added. ‘But the chest pain and arm pain persist. The pain even seems to radiate to my back. I am tormented by the conviction that this is a heart attack.‘
Case 3: The Cancer Fear
Another client came to me after consulting various specialists who could not pinpoint a diagnosis. He concluded, ‘I believe this is blood cancer. I’ve been told that with blood cancer, all initial reports often come back normal.‘ Following this conviction, and without a definitive diagnosis from other doctors, he went to a cancer hospital. All their tests there, too, came back normal. However, he remains convinced, ‘I do have cancer. The doctors haven’t been able to detect it.‘
One doctor, he recounted, finally suggested, ‘You should see a psychiatrist.‘ This suggestion infuriated him. ‘I even scolded the doctor: Why are you sending me to a psychiatrist? I have a real physical problem! My body hurts, I have stinging, burning sensations!‘ He refused to accept the referral. Only after every single test came back normal and he reluctantly came to see me. He still maintained, ‘I believe there is a serious problem in my body that the doctors are failing to find.‘
Understanding the Phenomenon
The number of patients presenting with such concerns is steadily increasing: people with headaches seeing multiple neurologists, getting CT scans and MRIs; people worried about stomach cancer or ulcers undergoing repeated endoscopies, colonoscopies, and CT scans with no abnormal findings; and people with chest discomfort constantly rushing for ECGs and echocardiograms.
Even when the reports are normal, their mind refuses to be reassured. They think, ‘My chest still hurts, why should I see a mental health professional? I’m not making this up.’
The core issue here is that these are often psychological problems where the mental symptoms are minimal, but the physical symptoms are dominant. They may not exhibit classic symptoms like low mood or hopelessness. Instead, they manifest with physical complaints such as burning sensations, tingling, numbness, pain, or a feeling of a lump in the throat (globus sensation)—often leading to repeated endoscopies to rule out throat cancer. All reports are normal, and only then, often reluctantly, do they seek psychiatric help.
The Mind-Body Connection
It is crucial to understand the relationship between the brain and the mind, as this system controls the entire body. When we fail to recognize the profound influence of the mind on bodily functions, we tend to fixate on a physical cause.
The brain and mind control your entire physical system. Many times, even if there is no physical problem in the stomach or feet, the mind can cause stomach pain, or tingling, burning, or heat in the limbs. The mind can also cause the sensation of a lump in the throat.
Your mind takes that small, normal bodily sensation and amplifies it. A sore throat, which could be due to a simple viral infection, cold, or tonsillitis, is immediately interpreted by the mind as a catastrophic event—’Oh, I must have a tumor in my throat.’
This tendency to take a minor symptom and escalate it into the conviction of a serious illness is what we refer to as Illness Anxiety Disorder (formerly known as Hypochondriasis).
In this condition, despite medical reassurance, the individual believes they have a serious physical illness that all doctors have missed, and that they are going to die soon. They are often not satisfied with a normal report; they may even be happier if a report shows an anomaly, validating their fears. This illustrates how the mind and body are intricately connected and how the mind’s distress can be expressed entirely through physical symptoms.
In conclusion, these cases highlight a critical juncture in modern medicine: the intimate connection between the mind and the body. When chronic stress, anxiety, or deep-seated fears remain unaddressed, they often translate into tangible, persistent physical symptoms—be it chronic headaches, chest pain, or the relentless fear of a serious disease. Recognizing that the brain and mind govern every aspect of the body is key. The goal isn’t to dismiss the patient’s pain, but to shift the focus from relentless, often unnecessary, physical investigations to addressing the underlying Illness Anxiety Disorder and emotional distress that manifests as physical suffering.
