The relationship between stress and somatizations

Somatizations are often caused by problems related to anxiety and stress.

Stress and anxiety are problems more and more present in today's society.. According to the World Health Organization (WHO), about 260 million people around the world suffer from some kind of anxiety problem, either transient or generalized.

Generalized anxiety disorder (GAD) is a clinical entity of particular concern, as it is estimated that up to 5% of the population in high-income countries suffer from it. The lifetime prevalence is up to 8%, meaning that as many as 8 out of every 100 people will suffer from this disorder in the long term at some point.

Transient stress is a good thing, as it is clearly an adaptive response. When we feel stressed, the cortisol released promotes glucose synthesis from non-glucose precursors (gluconeogenesis), suppresses the immune system and promotes the metabolism of fats, proteins and carbohydrates. Likewise, adrenaline increases the heart rate, constricts Blood vessels, dilates the bronchi and much more. The answer is clear: to prepare the body for fight or flight.

In the short term, these hormones prepare us to be as active as possible in a dangerous situation and to respond with maximum biological efficiency. The sharpness of our reflexes at these moments and the amount of energy obtained by our metabolism can literally save our lives. The problem occurs when this state of alertness goes from being transitory to chronic, as it can take its toll on the whole organism. Based on this premise, we tell you everything about stress and somatizations.

Stress or anxiety?

First of all, it is necessary to establish a few bases as far as these terms are concerned. Stress is the immediate physiological response that we have just described, of rapid onset and ephemeral nature.. Once the exogenous trigger (a loud noise, a fright, a barking dog or the realization that you have lost your keys) disappears, the patient's physiological situation stabilizes.

Unfortunately, anxiety persists once the immediate problem is no longer present. Moreover, if the symptomatology remains, the anxiety goes from being a slightly more prolonged physiological event to a pathology that needs to be treated: generalized anxiety disorder (GAD).. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (APA), GAD is characterized by the following events:

• The patient presents with significant anxiety, worry, and apprehension for at least 6 months.
• The patient cannot control his or her worry even if he or she tries.
• The anxiety is associated with 3 or more of the following symptoms: restlessness, fatigue, muscle tension, sleep disturbances, irritability and difficulty concentrating.
• GAD is not due to substance abuse or the use of certain drugs and/or physiological diseases.
• Anxiety causes significant clinical distress that hinders the patient's performance in social and occupational settings.

As you can see, the differential line between anxiety and GAD is fine, but mostly lies in the time scale in which the symptoms are recorded. It is normal to feel anxious a few days before receiving the answer to a job interview, but not to spend half a year with the symptoms described above.

Relationships between stress, anxiety and somatization.

We have already made it clear that stress is transitory and natural, anxiety usually stays longer and GAD is chronic in nature and is considered a pathology. This was necessary, because in reality, somatization is much more related to GAD than to the other variants of GAD..

The term "somatization", in medical practice, refers to physical complaints that cause discomfort, in the absence of clinical findings to justify an organic cause. It is a very common reason for a visit to primary care (up to 25% of cases). and, interestingly, up to 70% of the pain presented by these people remains an unknown even after medical evaluation.

Here we enter another pathological group: somatic symptom disorder (SSD). As indicated in the medical article Somatic Syndrome Disorders, published on the StatPearls portal, this disorder is considered as such when the patient presents with the following clinical signs:

• Somatic symptoms that make it difficult or impossible for the patient to lead an appropriate lifestyle. These usually manifest in the form of dyspepsia (upset stomach), abdominal pain, fatigue, dizziness and insomnia, and headache.
• Thoughts, feelings and/or behaviors related to somatic symptoms. These thoughts are repetitive and report high levels of anxiety.
• Symptoms last for more than 6 months.

The study "The Relationship Between Symptoms of Anxiety and Somatic Symptoms in Health Professionals During the Coronavirus Disease 2019 Pandemic" investigated the correlation between anxiety and somatization in a group of health professionals (N=606) during the early stages of the COVID-19 pandemic. This sample group was chosen because of the intense worry that these workers suffered at almost all times in the hospital setting and because of the uniqueness of the situation.

This study showed that more than 20 % of the health professionals with somatic symptoms also had anxiety or generalized anxietywhich establishes a not inconsiderable correlation between the two events.

As if this were not enough, one of the clearest symptoms of GAD is stomach pain and gastrointestinal disturbances. Pains and pins and needles in the stomach are one of the first signs of anxiety, as peristaltic contractions and unnecessary muscle movements occur in response to physiological imbalance. The patient does not have an ulcer or a tumor, but it is the stress and anxiety itself that is causing the pain that worries him so much.

Is there a correlation?

For a somatic symptom disorder (SSD) to occur, the patient must have repetitive thoughts about his or her pain and these thoughts must cause some degree of anxiety.. This criterion is necessary for the diagnosis of the pathology, so stress and anxiety are a requirement for SSS to take place.

On the other hand, not all people with stress and anxiety develop TTS, but as we have seen, there is at least a minimal causality between the two: the worry manifests itself physically and the pain exacerbates the worry. Beyond objective data, we want to close these lines with an idea: breaking this vicious circle is possible, but always with psychological help. If you feel persistent pain and all your tests and analyses have come back positive, perhaps your answer lies in the psychiatric field.