Learn how some psychological factors affecting abdominal pain diagnosis. Aside from specific diseases or bodily malfunctions, there are also psychogenic, or mind-related, factors that may cause or affect the perception of abdominal pain. Sometimes a patient may be surprised to hear from his physician that no physiological cause at all can be found for his complaints and that the source of his discomfort can probably be traced to “nerves,” depression, or some other psychological process. This does mean that the pain is “all in patient’s mind,” however. The pain is every bit as real as the patient feels it is What is implied, though, is that there is no pathological process going on within the body to cause the pain and that the pain can probably be eliminated if the patient’s psychology, or some factors affecting it, can be adjusted.
Nervousness, depression or anxiety
Some psychological factors, such as nervousness, depression or anxiety may become part of a person’s character early in life, and will not be easy to dispel. Also, it may be difficult or impossible to either the physician or the patient to deal effectively with the pain when it results, at least in part, from the patient’s reactions to some basic aspect of his life situation. If for example, a man’s gastric distress can be traced, to some extent, to the effect on his anxiety-prone nature of a highly critical and demanding boss or wife, there might be little hope for the cure without a change of job or marital status.
Often, the best that can be hoped for in such a case is for the patient to learn to identify and to try to cope with the external causes of his distress. The physician may also be able to help the patient, in some cases, by prescribing a drug that may give symptomatic relief, or by prescribing a mild tranquilizer. The tranquilizer will neither treat the abdominal symptoms nor eliminate the basic causes of the patient’s distress but may help the patient to take things more in stride, and thus hopefully prevent the Symptoms from occurring too often. It should not be assumed, however, that abdominal pain of psychogenic origin is experienced only by highly emotional, high-strung, or maladjusted people.
In fact, there is hardly a person who has not experienced some such distress at some point in his lifetime. A
common example would be the person who begins to feel faint or nauseated after witnessing a violent automobile accident and seeing the casualties. Another example with which many can undoubtedly identify is that of the person who develops an upset stomach after an especially long, difficult, and frustrating day at the office or elsewhere. Some individuals might develop a headache in such a situation; for others, it is the abdomen that pays the price for the day’s frustration.
Tummy ache and stomach ache
In addition, some individuals, thoroughly normal by ordinary psychological standards, may unconsciously develop the technique of using abdominal pain as a means of avoiding certain unpleasant situations. Such an individual may learn as a child that if he has a tummy ache he will not be expected to go school. He may then feign a tummy ache on occasion. in order to have an acceptable excuse for playing hooky. By the time such an Individual reaches high school or college, he may find that he actually gets a stomach ache on a day when he is expected to take an exam or give a report. What has happened is that he has internalized the avoidance technique of his childhood to the extent that it can convince even himself.
A medical examination would reveal nothing wrong, but the abdominal distress will be real enough to prevent him from doing something that he wanted to do that day, as well as he keeps him out of the situation he wished to avoid. In later years, such a person may develop abdomen symptoms whenever he wants strenuously to avoid some demanding or unpleasant situation, and he may have no more control over the symptoms than he would if they were the product of some organic disease, In a normal person, however, such reactions would be relatively rare and would not prevent him from living a useful life undertaking normal responsibilities.
Just a psychological factors can produce physical pain, it is also true that these factors can sometimes provoke or aggravate a physiological condition that then causes pain of its own. The ability of tension and frustration to help produce or to intensify the pain of an ulcer, for example, is well-known. And while it may be true that tension and frustration alone might not be sufficient to provoke an ulcer, it is probably equally true that many whose physiology might dispose them toward an ulcer would never actually develop one without the action of the psychological factors.
There are other abdominal conditions, as well, that can be at least partly psychogenic in nature, while Showing up mainly as physiological disorders. And almost any physical condition—in the abdomen or else. where—can be affected by how the patient feels about it, or how he reacts to the sensations it produces. In the case of the abdomen, where the pain is often vague and diffuse, an important psychological aspect is how the patient perceives the pain. A stoic individual may attempt to “sleep off” a pain that might send a more excitable person to the hospital emergency room. In between these extremes, individuals will respond in varying degrees to similar levels of pain and may consider themselves either more or less ill than the medical facts would indicate.
In almost any individual, however, the perception of pain will be affected by various states of mind or activity. Most of us intuitively recognize the fact that a stomachache, even if clearly due to some physical cause, such as overeating, will appear worse if we are feeling tense or tired, or have a busy day ahead of us. Estimates vary as to the importance of psychological factors in producing abdominal pain of mild to moderate intensity, but some physicians believe that half or more of all abdominal complaints of this severity may be traced ultimately to the psyche. In many such cases, the main functions of the physician will be to provide sympathetic understanding and reassurance, symptomatic relief, and perhaps a mild sedative or tranquilizer.
Rarely do wholly psychogenic processes induce abdominal pain of extreme severity, except occasionally in highly disturbed or psychotic individuals. Such persons might be given mind-regulating drugs in an attempt to adjust the disordered mental process responsible for the pain, and undoubtedly would be referred for psychiatric care.