Somatisation
Immature defence (Vaillant's hypochondriasis). Emotional distress is experienced and communicated as bodily symptoms rather than as feelings.
What drives it
Turns an unacceptable or unnameable feeling into a physical complaint, which gets care, legitimises withdrawal and spares the person from admitting emotional need.
How it shows
Work
Migraines before every board meeting; back pain that flares during a reorganisation. Talks readily about symptoms and doctors, not about stress. Sick days cluster around conflict. Colleagues feel sympathy and a quiet frustration that the obvious stressor is never mentioned.
Relationships
Stomach aches in a child who can't say they're frightened; an adult who falls ill whenever a partner plans to travel. Care arrives through the body, so the illness carries the relationship.
Self
Your physical symptoms track your calendar. You can describe the headache in detail but not your mood.
What tells it apart
Health anxiety: Health anxiety is fear of having a disease, with checking and reassurance-seeking; somatisation produces real symptoms with relatively little worry about what they mean.
Primary and secondary gain: Secondary gain is the benefit that keeps a symptom going; somatisation is the conversion of distress into the symptom, and the two often coexist.
Alexithymia: Alexithymia is a stable difficulty naming feelings; somatisation is one outlet for it and appears specifically under stress.
A test
Once medical causes have been checked, track symptoms against emotional events over a few weeks; a tight fit with stressors the person doesn't name suggests somatisation.
Questions to carry
- Over a few weeks, how closely do the symptoms track the stresses the person never names?
- Where in my body does a feeling I haven’t said out loud tend to show up?
How strong the research is
clinical. The link between unexpressed distress and bodily symptoms is supported by research on alexithymia and somatic symptom disorder, but the defence model itself is hard to test.
Where it comes from
Wilhelm Stekel, 1920s; George Vaillant (hypochondriasis as an immature defence), 1977
Sources
- Josef Breuer and Sigmund Freud, Studies on Hysteria (1895)
- Gabor Maté, When the Body Says No: The Cost of Hidden Stress (2003)