When the mind causes physical symptoms: psychosomatic and functional symptoms
Psychosomatic or functional symptoms are real physical symptoms — pain, dizziness, chest tightness, burning, bowel upset, weakness or even seizures — caused by a problem in how the nervous system is working rather than by damage to an organ. They are common: the NHS says about one in four people who see a GP have physical symptoms that cannot be explained by disease. They are not imagined or faked. Treatment starts with a clear explanation and often includes CBT, graded activity and treating any anxiety or depression.
Health writers · Aslam Clinic
Yes, the mind can cause physical symptoms — and those symptoms are real. The nervous system controls pain, heartbeat, breathing, the gut and movement. When it is working abnormally, often under stress but sometimes for no clear reason, it can produce pain, dizziness, a tight chest, a burning sensation, bowel upset, numbness or even seizures, while scans and blood tests show no damage. Doctors call these .
They are very common. The NHS estimates that about one in four people who see a GP have physical symptoms that cannot be explained by a disease. Understanding what is going on is often the first step to getting better.
Real, not imagined
The NHS is explicit: these symptoms are not faked or 'all in the head'. They are real and can seriously affect a person's ability to function. A helpful way to think of it comes from neurology: the hardware — the organs, nerves and brain structure — is intact, but the software — the way signals are processed — is not running properly. Brain imaging studies have shown parts of the brain working differently while functional symptoms are present, even though routine scans look normal.
This matters because being disbelieved is one of the worst parts of the experience. Saying 'there is nothing wrong with you' is inaccurate. Something is wrong — it just is not the kind of thing that shows on an X-ray.
Why functional symptoms happen
There is rarely a single cause. More often several things combine, and the mix is different for each person:
- A trigger — an infection, an injury, a minor operation, a panic attack or a faint can start the symptom off
- Stress and emotion — ongoing worry, grief, conflict at home or past trauma keep the body's alarm system primed
- Attention and worry — once a symptom is frightening, the brain monitors it closely, and that monitoring itself makes it louder
- Changes in behaviour — resting, avoiding activity and repeated checking are natural responses, but over time they keep the symptom going
The NHS describes this as a vicious circle: symptoms cause worry and low mood, which make the symptoms worse. Some people have no obvious stress at all, and that does not make the diagnosis wrong. Functional symptoms also overlap with recognised syndromes such as irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome.
Common presentations
Any part of the body can be involved. The table shows common functional symptoms — and the physical causes a doctor should consider first, especially for someone with diabetes.
| Symptom | How it may feel | Check first for |
|---|---|---|
| Chest tightness | Pressure, a band round the chest, difficulty taking a full breath | Heart disease, which can be silent or unusual in diabetes |
| Headaches | Constant pressure, 'sir mein bojh' | High blood pressure, migraine, eye strain, painkiller overuse |
| Dizziness | Swaying, light-headed, 'chakkar' | Low blood sugar, low blood pressure, anaemia, ear problems |
| Burning sensations | Burning hands, feet or body, 'jalan' | Diabetic nerve damage and vitamin B12 deficiency (common with long-term metformin) |
| Bowel symptoms | Pain, bloating, loose stools or constipation | Infection, coeliac disease, and bowel disease if there is bleeding or weight loss |
| Tiredness | Exhaustion that rest does not fix | Thyroid problems, anaemia, high blood sugar, depression, sleep apnoea |
| Weakness, numbness, fits | A limb that will not work, attacks of shaking or collapse | Stroke, epilepsy, multiple sclerosis |
Functional neurological disorder and functional seizures
Functional neurological disorder (FND) is one of the commonest reasons people see a neurologist: around 15% of new patients in UK neurology clinics have functional symptoms. It can cause weakness of an arm or leg, numbness, tremor, walking problems, speech difficulties and blackouts.
Functional seizures — also called dissociative or non-epileptic seizures — look like epilepsy but are not caused by abnormal electrical activity in the brain. They happen through , a temporary 'switching off' of normal awareness and control, often after a build-up of frightening physical sensations. They are common: nearly half of people brought to hospital with suspected epilepsy turn out to have them, and many have been wrongly treated with epilepsy medicines.
Importantly, FND is diagnosed from positive signs that a trained doctor finds on examination — not simply because tests are normal. Studies show the rate of later finding a different diagnosis is about 5%, similar to other neurological conditions. About 10–15% of people with functional seizures also have epilepsy, which is why assessment by someone experienced matters.
In Pakistan, attacks like these — especially in young women — are sometimes attributed to jinn, nazar or sehr, or dismissed as 'drama'. Families should be treated with respect whatever they believe, and prayer can sit alongside medical care. But seizures and collapses always need a doctor's assessment, and people with functional seizures deserve the same seriousness as anyone else.
Somatic symptom disorder
Somatic symptom disorder is a diagnosis in the American Psychiatric Association's . It is not given just because a medical cause cannot be found. It describes someone whose physical symptoms — explained or not — come with excessive, distressing thoughts, feelings and behaviours: constant worry about what the symptom means, high anxiety about health, or so much time and energy spent on symptoms that daily life suffers. The APA notes that people with it usually see a family doctor rather than a psychiatrist, and may keep worrying even after tests are reassuring.
Why 'all your tests are normal' is so frustrating
Normal results are good news, but they are not an explanation. Many patients hear 'your reports are clear, it's just tension' and walk out feeling dismissed, still in pain, and no wiser. The result is often a round of different doctors, repeated tests, injections and drips, and rising costs — each normal report making the person more convinced that something is being missed.
What helps is a doctor who names the problem ('you have functional symptoms'), explains how they work, and makes a plan — rather than simply saying what it is not.
How doctors approach it
- A careful history and examination, including what else is going on in your life.
- Targeted tests to rule out likely physical causes — not endless ones, which rarely help and can increase worry.
- A positive diagnosis and a clear explanation, using the to show what has been considered.
- Looking for and , which commonly accompany functional symptoms. Treating them often relieves the physical symptoms too.
- Regular follow-up with one trusted doctor, rather than a new doctor at every flare.
Treatment
- Explanation and — understanding the 'software' problem reduces fear, and fear itself amplifies symptoms.
- — helps you understand the links between symptoms, worries, feelings and what you do. A Cochrane review found CBT gave a modest improvement in symptoms compared with usual care.
- Graded activity and physiotherapy — building up activity step by step. For FND, specialist physiotherapy retrains movement.
- Treating anxiety, depression and sleep problems — sometimes with medicines. Some antidepressants also help pain and IBS.
- Avoiding what makes it worse — repeated injections and drips, tranquillisers such as alprazolam or bromazepam, and resting in bed for long periods.
The NHS notes that the body has a remarkable ability to recover, and many people's symptoms improve with time.
Red flags that must not be dismissed
Having had functional symptoms before does not protect anyone from a new physical illness. These signs need proper medical assessment, whatever your history:
- Chest pain on exertion or with breathlessness, sweating or nausea
- Unintended weight loss, fever, night sweats, or blood in stool, urine or vomit
- A first-ever seizure, a seizure with injury, or a change in the pattern of attacks
- Symptoms that are new after the age of 50, or steadily getting worse
- In diabetes: burning, numb or painful feet, which may be nerve damage needing foot care and treatment
What you can do
- Keep a simple diary of symptoms alongside sleep, stress and activity — patterns often appear.
- At your appointment, ask directly: 'What do you think this is, and what is the plan?'
- Stay as active as you can, building up gradually rather than resting until the symptom goes.
- Try to stay with one doctor who knows your history.
- Bring a family member, so they hear the explanation too and can support the plan.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
