Brain Changes Accompany Physical Symptoms: from digestive issues to fatigue

Faulty connections in the brain, newly visible with advances in neuroimaging, can help explain often debilitating symptoms that are difficult to diagnose—like dizziness and tremor, chronic fatigue, irritable bowel syndrome, and fibromyalgia—and dismissed by others, including doctors.

Alterations in the brain’s software affect ‘how brain networks work, rather than changes in the structure of the brain itself [that are] seen in many other neurological disorders,” according to the National Institute of Neurologic Disorders and Stroke (NINDS). These alterations disturb the brain’s ability to send and receive signals—to communicate with itself.

Cognitive problems, such as memory issues and difficulty concentrating, can arise along with physical symptoms that are characteristically inconsistent in frequency and severity. According to neurologists at NIH, Harvard, and other international centers, what are now called functional neurologic disorders (or FND) refer to “recognizable patterns of genuinely experienced symptoms [marked by] variability within and between tasks over time.”

“Psychological stressors are common risk factors,” the neurologists write—both recent exposure to stress and “histories of childhood adversity, particularly neglect.” That these kinds of symptoms are more common in women “is likely to be partly attributable to their higher frequency of childhood adversity.”

When a child’s needs have been ignored by caretakers, their body remains in a high state of alert, according to Harvard neurologist Bessel van der Kolk, author of The Body Keeps the Score, which as of June 1st, had spent 243 weeks on the New York Times nonfiction bestsellers list. Writes van der Kolk, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

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“Body-Centered Inquiry” is one way anyone can benefit from brain-body interactions. In a workshop run by the Insight Meditation Community of Washington, teacher Jonathan Foust explained, “When you get to the point in struggling with a problem that you think, ‘I’m sick of talking about this,’” then it’s time to focus on your body. Foust demonstrated how to look first at one option and then the other, to assess how the body responds to each, and then to choose the one causing the least physical discomfort.

What can be confusing about the neuroimaging research is that the same symptoms it links to software changes in the brain have also been labeled psychosomatic or “in the mind”— which has led doctors to dismiss such complaints. While distinctions between brain and mind have long been debated by philosophers, visible changes in the brain now appear to be affecting symptoms experienced by the mind.

The diagnosis of “hysteria”*—bestowed by early psychologist like Freud and Charcot on unusual physical behaviors in women and traced by them to disorders of the womb—still appears, as in a recent paper by Japanese neurologists. “FND, also known as hysteria or a conversion disorder, [is the diagnosis] for sensory symptoms and weakness,” they write, and describe research documenting these symptoms in about 15% of UK neurology clinic outpatients — including headache, peripheral nerve disorders, and fainting.

Hypochondria, a related diagnosis, disappeared from the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. Somatic Symptom Disorder, one of its replacements, refers to hard-to-diagnose physical symptoms “most often associated with significant distress and impairment,” according to Medscape. The other, Illness Anxiety Disorder, is “preoccupation with having or acquiring a serious, undiagnosed medical illness.”

Changes in the brain’s wiring can also explain conditions such as phantom-limb syndrome, when the brain retains its original map of limbs following amputation and the missing limb is painful. Instead of a psychological diagnosis, explains Scottish neurologist Jon Stone, “You would say, ‘Well that’s a kind of brain problem.’” Another example is motion sickness that persists long after a person has left a moving vehicle, sometimes for weeks or years, often causing debilitating fatigue and dizziness.

Persistent dizziness and fatigue as well as cognitive problems that worsen over time are also symptoms of so-called Havana Syndrome, dismissed as lacking physiological evidence when first reported by State Department employees assigned to the American embassy in Cuba. Stone notes that the disordered brain function of “FND is certainly not the only explanation for patients with Havana syndrome, but it shows just how powerful and complicated the brain can be.”

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Therapies for FND symptoms should address both mind and body, according to van der Kolk. As explained in The Guardian, he believes that “the body does not forget [and] the rational mind cannot do the repair work on its own since that part of you is pretending it has already been repaired.” Effects deep in the brain revealed by brain imaging studies “cannot be eliminated by reasoning or understanding” and require other therapies, such as yoga, massage, or psychedelic drugs.

Documenting either disturbances or improvements in brain activity linked to specific therapies, however, is challenging. “Even the resting brain is highly variable in activity and constantly adapting to its internal and external environment,” explain Swiss researchers, who are looking at changes in the brain following, for example, cognitive behavior therapy. In a study of functional tremor — tremor with no obvious physical cause — 12 weeks of CBT led to “significant improvement”* in severity accompanied by decreased activation in one area of the brain.

Tremor associated with disease such as Parkinson’s generally occurs when at rest, while “action tremor” that occurs during movement indicates essential tremor—though telling the difference isn’t always simple.

I’ve always considered the tremor I’ve had since childhood—usually mild but worse when carrying items such as teacups in saucers—to be “essential tremor,” which is typically inherited and appears early in life. What can differentiate functional tremor is both inconsistency and tendency to disappear with distraction. But lacking medical confirmation, my tremor is similar enough to functional tremor that reading van der Kolk makes me think CBT could offer some relief. Meanwhile, my somewhat regular yoga classes might help stave off worsening tremor, whatever the cause, that can come with age.