Physical vs. Psychosomatic: What’s the Difference?

by Ruddy


I am in constant pain. I don’t mean emotional pain – dear me, please! I don’t feel emotional pain! – I mean physical pain. Aches and pains and creaking and groaning. Often I can identify a link between my inner pain and my physical pain. Sometimes I wonder what the difference is between physical and emotional pain. In this article I will discuss some of what I have learnt through experience and describe what helps me in the hope that it will help you too.

What is somatisation?

As I understand it, somatisation is the process where emotional pain, or unprocessed trauma, is transformed into physical pain. I see similarities between this and other things like conversion disorder, psychosomatic pain, and body memories. For me, it essentially boils down to: my heart can’t hurt any more, so my body has to take some of the hurt. Or: my heart refuses to hurt, so my body has to instead.

What causes it?

In my experience, the reasons behind somatisation are complex and the term somatisation seems to include many different types of pain. Dissociative disorders form when we are subjected to horrors which are too great to endure, and so we escape by escaping in our minds. We can’t cope with the memories or the knowledge, so we just don’t remember or know about it. The out-of-body experience of dissociation makes it seem as though we never felt anything. But unfortunately, I have found that my body does remember, and my mind does hold the knowledge and memories somewhere, even if I can’t or won’t access them.

What types of somatic pain are there?

For me, there are distinct types of somatic pain. These vary from person to person, and it can be difficult to distinguish one from another. This is my interpretation, each illustrated with the example of a sore neck.

  • Flashbacks. These are possibly the easiest to spot. If I’m having a flashback about something which really hurts my neck, it’s quite likely that my neck is going to be really sore during the flashback and for the rest of the day. I find that my mind gradually encourages (or forces) me to try to address this unprocessed trauma through flashbacks. I gradually put together the sensations and feelings that I should have felt at the time but didn’t because I couldn’t have coped with it.
  • Body memories. Sometimes the pain is the flashback itself. Traumatic memories are stored in a fragmented way, so very often I experience flashbacks as just a smell, or a feeling, or a pain. If I have a sore neck but without a clear flashback telling me why, it’s likely that this is my body remembering.
  • DID: other parts’ flashbacks. I have DID, which means that separate parts of myself hold different memories separate from me. If I have a sore neck, it is possible that another part is having flashbacks and re-experiencing the thing that hurt the neck, and the pain is leaking through to me.
  • Emotions. Sometimes I just can’t feel emotions, but my body feels them instead. In a situation where I should feel sad but instead feel completely numb, I sometimes notice that my neck, arm and back are really aching, or I feel sick, or I have a sudden headache.
  • Time of year/ anniversaries. My physical pain gets particularly bad at certain times of the year around bad dates, and the type of pain is slightly different. My aches and pains get much more achey and painful and I often become physically unwell, for example I get a cold. This is partly because I don’t look after myself as well during these times and can’t sleep well, so my body becomes run down and vulnerable to getting ill. But I think it is also due to the emotional impact of these times which is too huge for me to feel, as well being due to the memories of the body. This pain is usually more of an ache rather than an acute pain.
  • Dissociating what I can’t cope with. I have to admit to you that sometimes, when I can’t cope with a feeling any more, I scrunch it all up and shove it into my fist. Ta da! No longer do I feel sad… But I do now have an extremely painful hand. We who dissociate are very resourceful at finding ways to cope with things that are more than we can cope with. That’s not to say that it is healthy in the long run, but in the short term it does help us to survive. This type of pain differs from the others because it can be a way to cope with current issues, or it can be like a vent to reduce the emotional pain to a manageable level.
  • Unknown. Sometimes I just can’t work it out. Sometimes I am just left with aching niggling burning tingling crawling nauseous agonising pain. This could be memories that I’m not aware of yet, or as yet unknown parts having flashbacks, or body memories which I don’t want to piece together, or bad dates that I don’t know of. It could also be the general impact and aftermath of what I have been through. I should feel deeply grieving about everything that has happened to me, but I just can’t cope with the depth of my grief all the time. So perhaps my body carries the legacy of my experiences in it’s constant pain.

What’s the difference between psychosomatic and physical pain?

I have a checklist for myself which is based on what has worked for me in the past. This checklist may differ from person to person, and it is not a substitute for medical advice.

Psychosomatic pain:

  • Are you having flashbacks?
  • Are you aware of any underlying flashbacks?
  • If you have DID, are you aware of any parts who are having a particularly bad time?
  • Has something upset you or triggered you?
  • Are you around a bad date?
  • Can you match the pain to a memory?
  • Are you feeling overwhelmed?

Physical pain:

  • Is the answer to all the above no?
  • Have you been around anyone recently who was ill?
  • Do you travel on public transport? Are you often around children? Do you go to the doctors a lot?
  • If you are female, are you or are you about to be on your period?
  • Do the physical symptoms match up to typical symptoms for the season? For example, if you have a cold in the winter then it is possible that you just have a cold, but if you have a cold in the middle of the summer then it may be psychosomatic.
  • Do painkillers/ appropriate medication in the appropriate dosage help?
  • Do you have any other issues which impact on your physical health? For example, if you have an eating disorder, this could be affecting your body.
  • Is it possible that your bad experiences could have caused a physical problem in your body that needs checking out by a doctor?
  • Have you consulted a (good) doctor?

What can you do to improve psychosomatic pain?

The following are some suggestions based on what has helped me. It isn’t a comprehensive list and some aspects of it may not be relevant to you, but I hope that it can help you or at least be a launchpad for your own ideas.

Firstly, and unfortunately, the best way I have found to fix psychosomatic pain is to deal with the root cause. I say unfortunately because of course none of us want to face up to the horrendous things that have happened to us. It is also unfortunate because it is not a quick fix. For me, this means years of therapy and constant outside-of-therapy therapeutic work. But we should actually look at this as fortunate, because it really is possible for us to fix our agonising pain and to come to terms with our experiences. It certainly isn’t easy, but it certainly is possible.

Secondly, it is important to ask why. I find it very empowering if I can work out the reason why I am in pain. I heard recently of a three step approach: 1. Notice it (in this case, notice the reason behind the pain). 2. Acknowledge it. 3. Let it go. Easier said than done! The point is that it is helpful to work out the root cause for the pain and to take control of the pain by knowing why, but it isn’t helpful to be a detective and dig too deep. The reason why you are feeling the pain physically is because it is too much to manage emotionally, so it’s not going to help the situation to investigate too thoroughly.

Thirdly, acknowledge it for what it is. It is all too easy to use physical pain to distract from the cause. I much prefer to feel sorry myself for my aching back than to open the can of worms that is the cause of the pain. But, as above, it is a much more effective pain relief to acknowledge that the can of worms is there.

Fourthly, look after yourself. Do whatever you do when you are triggered: deep breathing exercises, relaxation music or guided meditation, pilates or yoga, painting, running, having a scream, having a cry, writing, listening to your favourite music, put on some children’s cartoons, be around someone safe, talk to your therapist, post on a safe forum, distract yourself, watch a safe film… Do whatever you can to make yourself feel safe and soothed.

Fifthly, listen to what your body is telling you. Your pain might be showing you that you need to start acknowledging something, or that you need to talk about something in therapy, or that you’re taking on too much and you’re overwhelmed, or that you’re in a triggering situation. Value your body as another voice which deserves to be equally heard (another easier said than done!).

Sixthly, don’t blame yourself. Sometimes it can be hard not to feel guilty for being in pain. But it isn’t your fault that you’re hurting, and it’s good to notice it and take action by looking after your body and you.

Finally, have hope. It isn’t always going to be like this. It might be a while before it gets better, and it might fluctuate in strength and frequency, but it isn’t going to be like this for the rest of your life. I can’t promise that you will be pain-free, but I can say that it won’t always be at this intensity. This is just another part of reeling from horrific things and gradually picking yourselves up from it and moving forward. It isn’t always going to be like this: there is hope.