The relationship between stress and somatizations

Stress and anxiety are increasingly prevalent problems in today's society. According to the World Health Organization (WHO), some 260 million people around the globe suffer from some type of anxiety problem, be it temporary or generalized.

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

Transient stress is a good thing, as it is a clear adaptive response. When we feel stressed, the released cortisol favors the synthesis of glucose from non-precursors. carbohydrates (gluconeogenesis), suppresses the immune system and promotes the metabolism of fats, proteins and carbohydrates. In the same way, adrenaline increases the heart rate, constricts the blood vessels, dilates the bronchial tubes, and much more. The answer is clear: 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 reflexes at this time and the amount of energy obtained by metabolism can literally save our lives. The problem occurs when this state of alert goes from being transitory to chronic, as it can take its toll on the entire body. Based on this premise, we tell you everything about stress and somatizations.

• Related article: "Types of stress and their triggers"

Stress or anxiety?

First of all, it is necessary to lay a foundation when it comes to these terms. Stress is the immediate physiological response that we have just described, of rapid onset and ephemeral nature. Once the exogenous trigger disappears (a loud noise, a fright, a dog barking or realizing that you have lost the keys), the patient's physiological situation stabilizes.

Unfortunately, the anxiety persists once the immediate problem is not present. Also, if the symptoms remain, anxiety goes from being a slightly longer physiological event to a pathology that must 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 has significant anxiety, worry, and apprehension for at least 6 months.
• He cannot control his worry even if he tries.
• 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 discomfort that hinders the patient's performance in the social and work environment.

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

• You may be interested in: "Psychosomatic disorders: causes, symptoms and treatment"

Relationships between stress, anxiety and somatization

We have already made it clear that stress is transitory and natural, anxiety tends to stay 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 other variants.

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

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

• Somatic symptoms that make it difficult or prevent the patient from leading an adequate 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 healthcare professionals (N = 606) during the early stages of the virus pandemic COVID-19. This sample group was chosen due to the intense concern 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 healthcare professionals with somatic symptoms also had generalized anxiety or anxiety, which establishes a not inconsiderable correlation between both events.

As if this were not enough, one of the clearest symptoms of GAD is stomach pain and gastrointestinal disorders. The pains and stitches in the stomach are one of the first signs of a picture of anxiety, since produce peristaltic contractions and unnecessary muscle movements in response to the mismatch physiological. The patient does not have an ulcer or a tumor, but it is stress and anxiety itself that is causing the pain that worries him so much.

Is there a correlation?

For a somatic symptom disorder (TTS) to occur, the patient must present repetitive thoughts regarding her pains and these report a certain degree of anxiety. This criterion is necessary for the diagnosis of the pathology, so stress and anxiety are a requirement for TSS 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 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 analytics and tests have gone well, perhaps your answer is in the psychiatric field.