Serotonin deficiency could explain ‘imaginary’ somatic condition

Mental Health
When a person feels pain and doctors can’t figure out why, they often tell the person that their symptoms are psychological. A recently discovered biological cause could change the narrative.
woman experiencing neck pain seen from the back
People with heightened somatic awareness often experience pain in the neck and back.

Being told that one’s symptoms are a figment of one’s imagination can be a torment. But this is often the experience of people with one condition in particular.

Heightened somatic awareness has more than one name in the medical world. It is also known as bodily distress, functional disorders, or even “medically unexplained symptoms.”

Experts define it as pain that has no detectable physiological cause.

The most common symptoms of heightened somatic awareness tend to be headaches, fatigue, painful muscles and joints, and stomach trouble. Some people also report memory impairment, dizziness, and breathlessness.

People with heightened somatic awareness are twice as likely to experience chronic pain, and they often receive diagnoses of conditions such as irritable bowel syndrome, fibromyalgia, and rheumatoid arthritis. Some people may never get an accurate diagnosis, resulting in increased levels of distress.

The cause of heightened somatic awareness is unclear. Experts have named everything from hereditary factors and brain malfunctions to life stressors as potential causes.

Some healthcare professionals still see it as a psychological problem and recommend cognitive behavioral therapy, commonly called CBT, as an unmedicated treatment.

However, a team helmed by researchers at McGill University, in Montreal, Canada, has now found a potential biological cause of the condition. Their findings are published in the journal Annals of Neurology.

A biological cause

Samar Khoury, Ph.D., from McGill University’s Alan Edwards Centre for Research on Pain likens the findings to the tale of “The Princess and the Pea.”

“The princess in the story had extreme sensitivity, where she could feel a small pea through a pile of 20 mattresses,” says Khoury, who is the first author of the study.

“This is a good analogy of how someone with heightened somatic awareness might feel; they have discomforts caused by a tiny pea that doctors can’t seem to find or see, but which is very real.”

The results of the team’s study may provide proof that the pea exists — that symptoms of heightened somatic awareness aren’t imaginary.

Data came from a preexisting study, the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cohort. This 7-year research project recruited 3,200 individuals to analyze both the physiological and psychological factors that led to the onset of temporomandibular disorder.

This condition is a problem affecting muscles used for chewing and the joints between the lower jaw and skull. Symptoms often involve pain in the jaw and face, headaches, and pain in other areas of the body, such as the neck and back.

The OPPERA study also closely examined genetic links, making it an attractive prospect for somatic awareness researchers.

Treating somatic symptoms

The team behind the present study used this data set to find a relationship between somatic symptoms and a genetic mutation. People with the gene variation had lower serotonin levels, as the enzyme needed to create the chemical did not work in the way that it should.

Serotonin plays a hugely important role in the body. Not only does it regulate mood and contribute to happiness levels, but it also helps with the function of the bowel and central nervous system.

Low levels of the chemical have already been linked to psychological issues, such as depression, and physical problems, involving fatigue, nausea, and digestion. There is now a case for associating the deficiency with heightened somatic awareness.

Lead author Dr. Luda Diatchenko described the findings as “very important.”

We can now provide a biological explanation of [the] symptoms. The next step for us would be to see if we are able to target serotonin levels in order to alleviate these symptoms.”

Dr. Luda Diatchenko

Using the new findings as the basis for a new treatment is likely to take some time. But the genetic mutation could steer further studies in the right direction.

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