What causes your body stress systems to develop functional symptoms?

In my second blogpost, I mentioned that Kirralee finally found a path to recovery, but not until she understood the cause of her functional symptoms, in her case, recurrent and severe heart palpitations.

For her to begin the path to recovery, she needed to learn about the fundamentals of how her body responded to its environment, real or perceived.

Kirralee came to understand that her body had two settings, or modes, necessary to stay safe and well in whatever environment. When all was well, and she was comfortable and relaxed, her body operated in the restorative and maintenance mode (see note below), which allowed her to sit quietly or eat comfortably, for example. Sometimes called the “Rest and Digest” state, the restorative mode is when, for example, her heart was beating at a normal rate, and she produced enough saliva and other digestive juices to process her meal.

If, however, she experienced any sort of demand upon her body, her body would automatically switch to the defensive mode: her mouth would dry, her heart rate increase and many other processes would be activated. These demands, or stressors, can take many different forms, from normal quotidian experiences, such as work pressure or rushing, to emotional demands or recall of past threats.

Stress vs stressors

I prefer to use the word ‘stressor’ to describe anything that makes the body or brain react.

I avoid the term, ‘stress’ as it is an oversimplified concept. Stress is often thought to mean that conscious state when you are aware of pressures that are more than you can manage with ease. In the previous blogpost, I described how I could easily cope with the intensive care workload and even enjoy it, but my body stress systems got activated and that was enough to trigger my abdominal pain.

So, you don’t need to expose yourself to extreme scenarios to trigger symptoms: many stressors are quite commonplace and indeed not even consciously registered.

When I talk about stressors, it is anything that causes a physiological change in your body, not simply a feeling of being overwhelmed. Some stressors are so trivial that you may not notice them, but some are completely overwhelming.

Here is a simplified picture, much of which will be familiar to you. The stressors on the left will activate your defensive mode. Listed below are some of the effects on one of your body stress systems:

 As you can see, most people would not consider a change in temperature to be a stress, but your body certainly does and it has to activate several stress responses to keep you alive. This is a normal response in your body.

You will learn more about your body’s vital survival responses in Chapter 3 of my book, ‘What the hell is wrong with me?’

But for now, what we all need to recognise is that, for reasons we don't fully understand yet, some people's defensive mode goes awry and creates a lot of unwelcome and hard to control symptoms. Due to the change in the functioning of the body, rather than the body itself, we call these symptoms functional.

In other words, functional symptoms can arise when the normal stress response systems are disrupted by the defensive mode activation.

The good news is that in the specialist clinics where functional conditions are treated, research has shown that if we can re-establish and maintain the restorative mode, we will be less likely to trigger the abnormal response to that leads to functional symptoms. Some retraining of the systems is often necessary to stabilise this.

How we do this is described in my book. For now, it would be good for you to observe how often your body and mind are both in a state of deep relaxation. Because, for you to enjoy normal health, your body must remain in restorative mode for most of the time.

This is an unfamiliar concept for a lot of people, especially those who believe that they need to push themselves beyond their natural limits, all the time. Some have an inner slave driver determined to extract the last bit of energy out of the body.

Your body is built to tolerate some stressors, of course, which is why exercise is good for you. Exposure to some stressor, followed by rest, maintains a healthy, resilient body. But we need to return to restorative mode for the body to recover. Relentless or extreme stressors seems to disrupt the normal response and functional symptoms arise.

Everyone gets functional symptoms

I need to mention here that functional symptoms occur to EVERYONE. Fortunately for most, these symptoms settle quickly. Examples of commonplace functional symptoms are:

• Painful neck muscles after too long at the desk

• Disrupted sleep before an important event

• A tic in your eyelid

• A sudden pain in the abdomen that settles quickly

These are just some of the everyday experiences of all of us. These are real symptoms but there is no disease process. The symptoms often resolve when our bodies return to restorative mode.

But sometimes, symptoms can be severe, disabling and prolonged. In such a situation, a systematic approach is needed, often using a team of experts who understand how to restore normal functioning. (This, of course, should happen AFTER your doctor has ruled out any physical disease.)

So far, we know

• your symptoms are real and

• once your doctor has ruled out physical illnesses, we need to start looking at your symptoms in a different light

• functional symptoms can arise anywhere in the body

• it should be a huge relief that, however nasty your symptoms are, they are not doing any harm to your body, nor is there any reason to think your body has a problem

• some of the causes are well understood

• there is no need to find the causes before treatment can start

We will explore some of the treatment options in my book, but the broad objective is to ensure you are remaining in your restorative mode most of the time.

Note: The terms restorative and maintenance mode and defensive mode were developed by Professor Kasia Kozlowska, director of the Mind Body Unit at Westmead Hospital.