Something torn or burst or unbearable: a psychoanalytically-informed exploration of the experience of somatic symptoms

Abstract

Experiences of and responses to bodily symptoms have long held interest, from earlier roots in hysteria to the most recent category of somatic symptom disorder (SSD) in DSM 5. SSD’s focus on distress implies that symptoms hold meaning for individuals. This study used a psychoanalytically-informed, multiple interview method and analysis to explore such possible meanings. Six participants were interviewed on three occasions each, with four themes emerging as follows: (1) a foreign body in charge; (2) left alone with the foreign body; (3) the body works for the mind; and (4) the body mirrors the mind. Bion’s idea of an active container-contained function and the construct of psychic pain formed a useful framework for understanding themes. The distress that lies in somatic symptoms was formulated as potentially stemming from an initial difficulty with containment in the primary object relationship. It is argued that distress may indicate a struggle with suffering that is not only somatic but also psychological in nature; and that the symptomatic body may have reached its limits in containing psychic pain. Implications for working clinically include the importance of close and sustained attention, through the clinician’s reverie, to somatic and emotional feeling states to help guide treatment.

Keywords:

• somatic symptom disorder
• distress
• psychoanalytic
• container
• symptoms

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. In this paper, somatic symptom presentations and symptom presentations are treated as synonymous, referring to symptoms that cause distress and fitting criteria for SSD.

2. The study had two clinical advisors, a Principal Clinical Psychologist and a Consultant Psychiatrist.