Towards a deeper understanding of functional symptoms
If you have read my blog to date, you know some of the facts about persistent or functional symptoms. To summarise to date:
- Your symptoms are real, experienced in the body – they not just “in your head”
- And yet, your body itself is not suffering from any physical diagnosis to cause them
- Research has shown functional symptoms arise due to a disruption to at least one of your seven body stress systems
- This can be due to spending more time in defensive mode and not enough in restorative mode, the state necessary for healing
- You have read about some of the factors that can disrupt your body stress systems
But why does this happen to you and not everyone else?
In this post, we will explore a little of what is known about how symptoms can arise, but it might be good to read my book to gain a better understanding.
The 4Ps and how you can use them to aid your recovery
In Chapter 8, I share Maree’s story of how she became so unwell, and I refer to some of her predisposing and precipitating factors, that resulted in her condition. Her remarkable story of recovery, identifying her perpetuating factors, as well as utilising her protective factors, is an inspiration for anyone struggling with disabling symptoms.
Maree was a clever, capable, energetic mother of two and hardworking self-employed young woman, with a devoted husband and supportive parents. But numerous elements in her life, each of which were not particularly noteworthy, could be called predisposing factors. Predisposing factors are those stressors in your life that drain your reserves and deplete your capacity to restore your body.
When we were able to examine all the predisposing factors, all the elements in Maree’s life that conspired to bring her to the brink, it was not so surprising that a few extra precipitating factors were enough to push her over the edge and into quite a serious condition, when she could no longer care for her own children, let alone work.
I encourage you to look at Maree’s story in my book, but for now, I will highlight some general examples of the 4Ps that you might relate to.
In the lists above are some of the factors that research has shown to be associated with functional conditions. As you read this, you might like to take a note of what factors are activated in your life that could be affecting your health.
Predisposing factors: “association is not causation”
When doctors ask a patient with chest pain if they are smokers or have diabetes, this helps them to decide if the risk of heart attack is more likely. But a risk factor is not a direct cause: just because you smoke doesn’t mean you have a heart attack. It is just more likely.
Similarly, predisposing factors, such as adverse childhood experiences (abuse, neglect), may increase the likelihood that your symptoms may be functional. But it is wrong to assume that this is the cause. Many people with adverse childhood experiences never suffer from functional illness and not every person with a functional illness has had adversity in childhood.
So, when a diagnosis is tricky and your doctor is asking a lot of questions, it may help to know that they are trying not to make any premature assumptions, but simply gathering as much information as possible to help with the diagnosis.
Often, I find my patients are so fixated on the symptom and all that it could mean that they have lost sight of the number of pressures upon them. Like Maree, it is amazing how much a human can withstand before something persistent symptoms arise.
Look at the examples of predisposing factors to see if you are at risk of functional conditions.
Precipitating factors
Precipitating factors can be very minor or severe. The person who bends over to pick up a piece of paper and gets severe back pain would agree the precipitating factor was trivial, but they may not recognise all the predisposing factors that led up to the straw that broke the camel’s back.
But more commonly, a major precipitant like a surgical procedure or a disease can be a trigger for functional symptoms. The challenge for your doctor is to establish what symptoms are due to your physical disease and what is due to your functional condition.
The Covid pandemic was a major precipitating factor for many. Not only did they suffer the physical illness, but the accumulated stressors of social isolation, financial hardship, uncertainty about the future, lack of any effective treatment, loss of physical fitness, disrupted routines and lack of support are recognised as significant precipitating factors that, in themselves, could lead to a lot of persistent symptoms.
It is not possible here to determine which is due to the physical effects of illness and which may be functional. As a doctor hoping to assist those with ongoing illness, I can only offer a trial of treatment mentioned in Part 3 of my book, while the brilliant minds researching the results of post-viral symptoms keep searching for better management.
Perpetuating factors
As you can see from the list above, your condition may have been perpetuated by a lack of timely management. This can be due to the doctor or the patient failing to consider the possibility of a functional diagnosis. As discussed in Part 1 of my book, the lack of tests to prove a diagnosis always needs to be balanced by the fact that research units around the world are successfully treating functional conditions, using the management I have highlighted. It
Protective factors
The short list of factors above has been shown to bring about a quicker resolution of functional symptoms and it is worth looking at which of these you could draw upon to assist you in your recovery.
Support is so important when you have ongoing physical or functional symptoms. Gather a support team around you, but those three words, ‘active coping strategies’ are vital: seize control of your recovery and take active steps, guided by the best advice you can get, to build a path to recovery. Best wishes!