Symptom substitution: Why do MBS symptoms move and change over time?
Everyone who has MBS/TMS or works with people who have this syndrome knows about symptom substitution, which Dr. Sarno calls the symptom imperative. Freud wrote about it many years ago. For the purposes of MBS/TMS, it basically means that the manifestations of MBS/TMS can vary over time. They can move, shift or completely change within minutes, days or weeks. I had a lady in one of my classes who came in with low back pain for seven years. After two weeks in the class, her low back pain was completely gone, but she had developed a pain in her neck. I had a 15 year old in one of my classes whose symptoms shifted over time from hip pain, to headaches, to chest pain, to loss of movement of his arm and leg (known as a conversion disorder in medical terminology, i.e. paralysis due to psychological, rather than physical, factors), to leg pain to fainting spells. I know someone who had groin pain, which morphed into back pain, then shifted into anxiety and OCD symptoms and then back again to the pain. It is amazing to watch MBS/TMS symptoms shift from day to day and week to week, even sometimes from minute to minute. This is especially interesting to see that the symptoms often involve both “physical” and “psychological” symptoms. This confirms that MBS/TMS can cause both sets of symptoms, such as pain and anxiety, diarrhea and OCD, urinary frequency and depression, rapid heart rate and fatigue.
When we see this kind of symptom substitution, we can usually easily confirm that the cause of this is truly MBS/TMS. There are very few medical diseases that have this type of pattern and therefore when we see this we are confident that the correct diagnosis is MBS/TMS, once serious medical conditions are ruled out. The reason symptoms can come and go, alter and change, or transform into new symptoms is that they are all caused by the same underlying physiological issues. These pathways are described in earlier blogs and consist of activation of the amgydala (emotional memory center), the anterior portion of the cingulate cortex (amplifies pain due to fear, worry and frustration), and the autonomic nervous system (activates the fight, flight or freeze reaction). These cause a variety of changes in the brain and body such as increase in muscle tension or muscle spasm, alteration or spasm of muscles in the bowel or urinary tract, activating or inhibiting nerve signals that control our activity and feelings. Once these nerve pathways get activated, they tend to quickly become sensitized and then “wired” to produce learned connections that develop a life of their own and can persist for months, years or even decades unless they are stopped by MBS/TMS therapy. Note that these are physiological changes, i.e. temporary alterations that do not produce tissue destruction or damage, as opposed to pathological changes, such as cancer or heart disease.