Episode 33: Psychosomatic Illness

psychosomatic symptoms

Many thanks to Suzanne O’Sullivan for her time in putting this podcast together. Her excellent books “It’s all in your head” and “Brainstorm” are well worth a read.


It is certainly one of the PHEMcast recordings which is going to change my own practice the most.


We can all find these patient’s challenging to look after – we often fail to communicate effectively and meaningfully. This is understandable as so much of our training and experience is based around the treatment of the physical condition.


The key things I took away from this interview were:


  • A vast majority of patients with psychosomatic symptoms have no control over their symptoms: even when they are made aware that there is no physical / pathological cause
  • By attributing psychosomatic symptoms to physical causes we are doing our patients a huge disservice
  • The sooner a psychosomatic cause for symptoms is identified and discussed with the patient the more likely they are to make a recovery
  • The misdiagnosis rate of a psychosomatic cause is low
  • There are several features of dissociative seizures that can help us distinguish them from true epileptic seizures
  • ‘Malingering’ (pretending to be unwell for gain) is extremely rare


There are a huge number of terms to describe psychosomatic illness – some of which are not useful. A common nomenclature here will help communication between both health care professionals and our patients.


Psychosomatic: a physical illness or other condition) caused or aggravated by a mental factor such as internal conflict or stress.


Non-epileptic seizures  = dissociative seizures.


The terms ‘functional’ and ‘supratentorial’ are best avoided!


As always please let us know your thoughts!


5 thoughts on “Episode 33: Psychosomatic Illness

  1. This is hugely fascinating. I attended a PT recently who was suffering from palpitations and pins and needles in her feet along with raised BP. After chatting to her, it became apparent that her life is manic and stressful. Advised that it might be a good idea to relax a bit more whilst she was under going her tests with cardiology. Now wondering if her symptoms are her bodies way of saying to slow down.


  2. I really enjoyed this podcast! I’ve had chronic back pain for the past 5 years that I’ve spent thousands of dollars getting physical therapy as well as mental therapy in coping with. I’ve only recently become aware that there is a high likelihood of psychosomatic issues playing a larger role than I first thought given my background. I wonder if you would have any book recommendations that address back pain from a psychosomatic approach?

    I also enjoyed the back pain podcast, but after having been working through this for the past 5 years, that information felt more like a good general review.


  3. Pingback: Things We Like This Month – January 2020 – Norwich PEM

  4. My daughter has both epileptic and PNES seizures. Her epileptic seizures can go on for a long time, we’ve been in hospital for status events several times. Also her epileptic seizures are focal, not generalised (mostly) so the whole yell, stiff limbs, convulsions are not typical for her. Conversely, her PNES events are characterised by extremely stiff limbs. The only thing I could relate to here was the eyes open vs closed. Also, she usually doesn’t need a sleep after PNES. 30% of epileptics also have PNES which makes it a whole lot more complicated.


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