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When Your Body Hurts But Nothing Seems to Be Wrong

Somatization is a process in which we express emotional changes and distress as physical symptoms and bodily complaints rather than in other ways (e.g., verbally). People who experience somatization can commonly find themselves feeling sick as a response to stress or big emotional changes, or have consistent physical symptoms including headaches, stomach aches, rashes, pain, fatigue, and feeling like there is a disturbance in organ functions (diarrhea, dizziness, etc.).

Importantly, these physical symptoms do not result from another physical or medical condition, and their psychological roots may not be easy to understand at first glance. If a person who’s experiencing somatization goes to a doctor, they may find that there is no illness or disease causing what they are experiencing, or that the treatments and care they receive do not relieve their complaints, even though the pain they are feeling is real.

Just as importantly, somatization is different from malingering, where a person acts as if they are ill when they are not. That is, for people who experience somatization, it’s not something they choose to do, and their physical discomfort and pain are real, even though the causes may be more psychological than physical (e.g., illness, viruses, etc.).

Why does it happen?

Our bodies and minds are linked and work together, which means that social, emotional, and mental events and experiences can cause, affect, or show up as bodily symptoms. Especially when we are growing up, we express distress through somatic or physical symptoms before we develop any language. In a way, somatization is one of the earliest ways we show distress, and it’s something we all experience. As we develop language, our distress can take more mature, regulated forms of expression and experience, which often help relieve it.

However, certain experiences and factors may make it more likely that we use somatization as the main, and sometimes only, way to express and metabolize emotional changes and distress, which can introduce additional distress and challenges into our lives.

Somatization doesn’t have a single cause, and many factors (environmental, genetic, social, etc.) likely interact to make someone more vulnerable to such experiences. Important contributors may include interruptions or missed developmental opportunities as we transition from somatic to verbal expressions of emotion while growing up, including not feeling safe enough to express and live through such experiences in alternative ways, or only receiving care and support when we are physically in distress. Such developmental experiences can lead and reinforce someone to continue expressing distress or emotional changes largely through somatic symptoms rather than more verbal expressions.

For example, experiencing more insecure forms of attachment or trauma may be some of the contributors to developing somatization as a way to express emotional changes and distress in later life. However, somatization can show up as more nuanced and needs to be approached with care and compassion to understand our unique experience with it.

Diagnoses and concepts related to somatization

Somatization is not necessarily a disorder on its own, but rather a way through which our bodies can express emotions and distress. When it becomes more frequent or intense, and when it replaces other ways of expressing and integrating emotional changes and distress, however, it can become limiting and create additional distress and suffering in our lives. 

Diagnostic manuals such as the DSM-5 and ICD note “Somatic Symptom Disorder” (DSM-5) and Somatoform Disorders or Bodily Distress Disorder (ICD-10) to describe some conditions where somatization can become more dysfunctional and limiting for the person. For example, Somatic Symptom Disorder is diagnosed when people experience one or more distressing somatic symptoms that cause additional distress and suffering in daily life, where the person also experiences increased thoughts and feelings about these, including disproportionate thoughts about the seriousness of the symptoms, excessive worry, and time dedicated to them.

People who experience somatization may also experience some other linked experiences that might be causing them additional stress, such as health-related anxiety or checking behaviors, where they may find themselves frequently monitoring their bodies, looking for signs that something might be wrong, or seeking reassurance about their symptoms. A related concept, Illness Anxiety Disorder (previously called hypochondriasis), is also noted in the DSM-5, where a person may become very worried or preoccupied with the possibility of having or developing a serious illness, even when there are few or no significant physical symptoms. 

The physical symptoms and mental and emotional overwhelm associated with somatization or similar experiences often also affect our quality of life, interfere with our capacity and energy levels for work and relationships. It can also cause financial strain through increased healthcare visits and bills, and it can leave us frustrated and hopeless. When this happens, we may find support by connecting with professionals to better understand our experience.

Culture & somatization

Cultural factors affect somatization experiences. For example, in some cultures, expressing distress and emotional difficulties through physical complaints or physical expressions may be more readily recognized as legitimate signs of distress than direct verbal expressions of psychological difficulties. This can be seen in significant differences in rituals around funerals, for example, where some cultures appreciate and encourage more bodily acts (crying, throwing yourself to the floor, wailing, and other forms of visible distress) versus expectations around containment in other cultures, where the same behaviors may be shamed or rejected by another community.

In certain families and communities, stigma around mental health can also make communicating emotional suffering through crying, physical weakness, headaches, stomach pain, or descriptions of bodily pain a way to receive greater sympathy, attention, or care than someone who simply states that they feel sad or anxious. Understanding these contextual reinforcements can help us understand one’s experience of somatization better and help them cultivate alternative ways that align with their unique needs and preferences.

Such cultural differences can also be reflected in a culture’s language, where one can find more words, phrases, or idioms that express emotional pain or suffering through bodily complaints. For example, in Turkish, emotional distress is commonly expressed through bodily language, such as içi yanmak (“one’s inside burns”), which can describe intense emotional pain and grief, or yüreği sızlamak (“one’s heart aches”), which can describe deep sadness or emotional pain instead of actual physical illness. Similar idioms appear across languages, too.

For example, in Italian one can say “avere un nodo alla gola” (meaning to have a knot in the throat) to refer to the feelings of sadness or the difficulty of holding back tears. Such nuances in language can reflect how we come to learn to name and understand our emotional experiences, rather than always representing somatization itself, and can interact with somatization in unique ways. 

These cultural and contextual patterns can affect how psychological distress is communicated and understood in therapy as well as how we differentiate between somatizing vs. culturally appropriate expressions of distress. That is why investigating the meaning behind certain expressions and symptoms is always needed to actually make sense of someone’s unique experience. As with somatization, bodily complaints can provide an entry point for exploring the client’s emotional experience, while still taking the physical symptoms themselves seriously. 

How can therapy help?

Therapy can help provide us with psychoeducation and help us learn how our body and mind are connected, which can help normalize experiences of somatization and can be a gentle start. Similarly, therapy can help us assess and monitor co-occurring conditions such as anxiety and depression and build more flexible and desired ways of coping with their often overwhelming effects.

Importantly, therapy can help us understand how and why other ways of expressing and living with emotions and distress, and managing stress, might be limited or disregarded, and cultivate a level of personal safety that is often necessary to express and integrate distress in more regulated ways. Together, these can help reintroduce or build alternative ways of expressing and regulating emotions and managing stress back into our lives. 

In time, such strategies may help us develop a greater sense of choice and flexibility in how we respond to emotions and distress. As we become better able to contain and express what we are experiencing in different ways, our bodies may have more space to regulate these experiences without relying as heavily on physical or bodily expressions of distress.

Takeaways:

  • Somatization is expressing emotional changes and distress as physical symptoms and bodily complaints even though there is not a direct physical condition or illness causing them. 
  • Somatization may become a main way of expressing distress when verbal or other forms of emotional expression become limited or unavailable due to a variety of factors, including environmental, genetic, social, and developmental and more.
  • While somatization is not necessarily a disorder, it can become frequent or intense or replace other ways of expressing distress and therefore can contribute to conditions such as Somatic Symptom Disorder and Illness Anxiety Disorder.
  • Cultural and family contexts influence how distress is expressed, understood, and reinforced, which can affect one’s somatic experiences. Bodily expressions of distress should therefore be interpreted within their cultural meaning, while still taking physical symptoms seriously and exploring the person’s unique emotional experience.
  • Therapy can provide psychoeducation, normalize the body-mind connection, address co-occurring anxiety or depression, and build more flexible ways of coping with distress.
  • Therapy can also help us develop personal safety and alternative ways of expressing and regulating emotions, equipping us with more choice and flexibility so our bodies do not have to rely as heavily on physical expressions of distress.

References & further reading

  • Charis, C., & Panayiotou, G. (Eds.). (2018). Somatoform and other psychosomatic disorders: A dialogue between contemporary psychodynamic psychotherapy and cognitive behavioral therapy perspectives. Springer International Publishing. https://doi.org/10.1007/978-3-319-89360-0 
  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  • Enfield, N. J., & Wierzbicka, A. (Eds.). (2002). The body in description of emotion: Cross-linguistic studies. Pragmatics & Cognition, 10(1–2).
  • Henningsen, P. (2018). Management of somatic symptom disorder. Dialogues in Clinical Neuroscience, 20(1), 23–31. https://doi.org/10.31887/dcns.2018.20.1/phenningsen
  • Karademas, E. C. (2018). Functional (medically unexplained) physical syndromes/symptoms: The cognitive behavioral perspective. In C. Charis & G. Panayiotou (Eds.), Somatoform and other psychosomatic disorders: A dialogue between contemporary psychodynamic psychotherapy and cognitive behavioral therapy perspectives (pp. 39–60). Springer International Publishing/Springer Nature. https://doi.org/10.1007/978-3-319-89360-0_3
  • Luyten, P., & Fonagy, P. (2020). Psychodynamic psychotherapy for patients with functional somatic disorders and the road to recovery. American Journal of Psychotherapy, 73(4), 125–130. https://doi.org/10.1176/appi.psychotherapy.20200010
  • Saunders, N. R., Kawamura, A., MacLeod, O., Nieuwesteeg, A., & De Souza, C. (2025). Somatic symptom and related disorders: Guidance on assessment and management for paediatric health care providers. Paediatrics & Child Health, 30(4), 331–337. https://doi.org/10.1093/pch/pxae115
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This page is also part of the Roamers Therapy Glossary; a collection of mental-health-related definitions that are written by our therapists.

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