Chapter 8: Diagnosing PPD Part II: Mental Health Conditions

Most people believe that when you suffer from Depression, an Anxiety Disorder or Post-Traumatic Stress Disorder (PTSD) it is obvious that you need care from a mental health professional. But for many people with these conditions, it is not obvious because they are manifesting with pain or illness instead of an emotional issue. 

For example, depression can cause pain or vague discomfort often accompanied by fatigue. Patients might feel stressed or frustrated but often do not feel particularly depressed. Depression also causes other symptoms that help reveal the underlying cause. These include:

• Loss of interest in formerly enjoyable activities (including sex)

• Poor appetite

• Low energy level

• Waking early in the morning with difficulty returning to sleep

• Crying for little or no reason

• Thoughts of harming yourself

Anxiety disorders cause anxiety, fear, worry, nervousness, or tension out of proportion to any reason for those feelings. However, as with depression the physical manifestation of the anxiety often is more prominent than these feelings. The range of body symptoms is large, from pain to muscle tension to bowel problems. A major clue that anxiety is responsible is that symptoms are less severe or less frequent when the patient is in what they believe to be a safe place.

One example is a patient who, for many months, had attacks of severe abdominal cramps followed quickly by diarrhea. These episodes occurred 2-3 times weekly but not one happened at her home where she felt safe. Another patient suffered muscle tension in his neck and shoulders but only away from home and especially around large numbers of people. A third example was a teenage athlete with bowel problems that only occurred on days when she was competing.

Body symptoms linked to a terrifying or horrifying event often begin soon after the trauma. Post-traumatic stress symptoms that can occur at the same time include:

• Flashbacks to the traumatic event

• Nightmares

• Extreme vigilance or anxiety

• Avoiding reminders of the trauma

• Insomnia

• Difficulty concentrating

• Irritability or anger outbursts

• Being easily startled

• Self-treatment with alcohol or drugs

“As with depression, the physical manifestation of the anxiety often is more prominent than these feelings.”

In some cases, the pain or illness begins long after the trauma. In this situation there is usually a triggering event that occurs just before the body symptoms begin. One of my patients suffered unexplained attacks of abdominal pain, nausea and vomiting every few months for several years. When I asked her to show me the location of the pain, she formed her hand into the shape of a pistol and pointed the ‘barrel’ at the right lower corner of her abdomen. Later she told me that ten years earlier, she had witnessed the shooting of her brother. The fatal gunshot was to the right lower corner of his abdomen.

She had no lasting symptoms in the years following his death. Then, just before her pain and vomiting began, she unexpectedly encountered her brother’s killer in a store. She was unaware he had been released from prison days earlier. Seeing him was a shock. Her symptoms began a day or two later.

Once the connection between pain or illness and Depression, Anxiety or PTSD is understood, well established techniques can be used to treat these conditions. These can involve psychotherapy, medication, or both. When the mental health condition improves, so will the symptoms in the body.