Psychosomatic symptoms are the physical and physiological experiences caused by mental or emotional conflict or distress, such as anxiety. Often, they are dismissed as being imagined or exaggerated, likely because they are part of someone’s internal experience. It is important to note psychosomatic symptoms are very real for the people experiencing them and can have a major impact on their ability to function and meet the demands of daily life. These psychosomatic symptoms are one of the most effective ways for clinicians to determine one’s internal distress. As hormones, like adrenaline and cortisol, are released during a stress response, our neurological and endocrine systems display the effects of that stress.
A simple way to think about these internal experiences is by comparing them to toothpaste inside the tube. No one can see the toothpaste until it is expressed, just as no one can see our internal experiences until they are expressed as words, actions, or even pain. Commonly experienced psychosomatic symptoms include changes in our breathing and/or heart rate, shakiness or trembling, tension in our muscles, headaches, backaches, temperature changes such as hot flashes or chills, tingling, numbness, shivers, stomachaches, digestive issues, sense of dread, panic, hopelessness.
Often, psychosomatic symptoms experienced by adolescents are a result of anxiety. Anxiety is not always a disorder; sometimes, anxiety is a necessary function that alerts our body to potential danger. It also may arise when anticipating something that may bring us physical or emotional discomfort, distress, or harm. For children and adolescents in school, this can include fear of failure or making mistakes on assignments or in front of peers. Another source of anxiety may be a lack of emotional safety resulting from negative past experiences, both at home and at school. During adolescence, there may be a developmentally appropriate lack of self-confidence, which can morph into a source of anxiety as it leads to negative self-talk and increased belief in negative outcomes. Students who lack effective self-regulation skills may experience higher anxiety due to an inability to self-soothe. Finally, poor sleep, hygiene, eating, and other poor self-care habits impede our adolescent’s ability to regulate, process, and manage their worlds, leading to mental and emotional distress.
A major factor contributing to the increase in psychosomatic symptoms, particularly in adolescents, is the effect of the coronavirus pandemic beginning in 2020. Experts are only beginning to study the effects of the pandemic but already see a significant increase in the frequencies of psychosomatic symptoms and negative emotions especially in younger people. Uncertainty is a huge component of anxiety. That, coupled with things like the fear of infection and the measures taken to stop the spread of the virus, add to the likelihood of emotional distress. Virtual schooling, masking, and isolation have impacted social and academic expectations and functioning. While attempting to prevent the spread of the virus, we may have also prevented the development of healthy coping, social, and problem-solving skills that students are naturally exposed to during in-person learning. Additionally, as children and adolescents were forced to cope with the loss of learning and the absence of social support, some unhealthy coping skills became more common.
Several challenges arise for children and adolescents struggling with psychosomatic symptoms. One of the most noticeable is avoidance or refusal of schoolwork or even going to school. Another psychosomatic symptom seen often in a school setting is hypo-arousal or “shutting down.” This may look like students who are unable or unwilling to make eye contact, appear withdrawn, refuse to talk or answer questions, or refuse to move to another room or make necessary transitions. At the opposite end of that spectrum, we may also see hyperarousal or explosive behavior in response to anxiety. This may look like yelling or shouting, throwing objects, hitting or kicking self and others, running around or even out of the classroom, and frequent or uncontrollable crying. Also of note, a potentially less noticeable manifestation of school-related stress and psychosomatic symptoms is a negative relationship to food or body image along with difficulty or refusal to eat in public.
Through awareness and understanding of psychosomatic symptoms and their causes, adults can help children and adolescents build resiliency and skills to manage stress responses and, in turn, psychosomatic symptoms. Cognitive behavioral therapy is an evidence-based therapy that focuses on the connections between our thoughts, emotions, and behaviors. CBT encourages examining and restructuring unhelpful thinking patterns, particularly those commonly associated with psychosomatic symptoms, including residual impacts of the pandemic. Adults can help adolescents identify and challenge negative self-talk, develop self-efficacy, and increase self-esteem through validation.
There are many school-based interventions for reducing psychosomatic symptoms and increasing emotional and academic functioning. First, providing psychoeducation on anxiety and psychosomatic symptoms can make it easier to manage. Everyone can benefit from increased emotional literacy, which consists of recognizing, identifying, understanding, expressing, and tolerating emotions in themselves and others. This is essential for self-regulation. Mindfulness can be used to regulate and reduce psychosomatic symptoms. Mindfulness can be thought of as a technique that involves noticing what’s happening in the present moment without judgment. Mindfulness practice can include relaxed breathing, which slows down the nervous system; grounding exercises like counting, talking to an adult, taking a walk, getting a drink, listening to music, writing or drawing, or doing something funny. Mindfulness practice can easily be individualized and implemented anywhere. Finally, developing a calming corner, which is a designated space in the classroom for dysregulated emotions with specific strategies to regulate and soothe, may benefit students.
Through increasing awareness of psychosomatic symptoms, we can reduce suffering for our adolescents and implement skills and strategies to resolve their sources. Most importantly, we increase connection and support by acknowledging things we cannot see but are still real.
First Children Services is a family-operated and family-centered organization of teachers, therapists, paraprofessionals, and support staff working with 80+ school districts throughout New Jersey and Pennsylvania to provide behavior therapy, counseling, and support services, and is in network with Medicaid and most major insurance companies in NJ and PA. The process of integrating mental health services with more traditional behavioral approaches like ABA is what sets us apart and is truly the best for the children and their families. We aim to build true continuums of care across all our service lines and populations and strive to deliver life-changing outcomes to exceptional kids.
