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Check your sources

Rule out physical issues before assuming problems are emotionally based

By Patti Carmalt-Vener 05/16/2013

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Dear Patti,
My daughter, Hannah, had acute asthma as a toddler and was rushed to the hospital numerous times. She’s now 14 and until just recently has been almost symptom-free for years. She’s under the care of a well-known specialist, but my worst fear is that she may get dangerously ill again. A close friend told me that asthma can be due to psychological issues. This might fit as Hannah has had what might be the most stressful year of her life. Her best friend since elementary school died in a car accident and about six months later Hannah had an asthma attack. I have strong faith in her physician, but I also don’t want to be missing any important component in my daughter.
— Mimi

Dear Patti,
My wife has frequent and extremely painful headaches. Her doctor doesn’t seem to think they’re migraines but my wife says that migraine headaches run in her family. She often has them around her menstrual cycle, which makes us wonder if they’re hormonal. She also tends to get more headaches when she’s upset. Could these headaches be rooted in emotional issues?  I hate to see her in pain.
— Danny

Dear Mimi and Danny,
Whenever there are physical symptoms, it’s critical to always rule out any medical problems before assuming they’re emotional in origin. Both asthma and headaches have many medical sources and factors, but if you have an existing medical condition, it’s always a good idea to try to keep stressful occurrences out of your life as much as possible. If you’re under a physician’s care and if the illness is known to be particularly stress-related, it may be beneficial to add a professional psychotherapist to your healing team to assist in psychological coping and dealing with feelings. Keep in mind that the role stress plays in relation to illness varies from one individual to the next.
Mimi — If you haven’t done so already, share your concerns with your daughter’s doctor that an extremely painful, life-changing experience of profound loss may have contributed to the return of Hannah’s asthma. Ask him if he might recommend a psychotherapist colleague to evaluate her. While there are lots of medical reasons for asthma to manifest, there may also be a psychological component triggered by conscious or repressed emotions including fear, anxiety, anger and grief. Emotional stress may precipitate or exacerbate acute and chronic asthma; specifically, some psychology researchers believe that repressing painful emotions, especially grief, can create tension in the chest area, making it harder to breathe and possibly contribute to an asthmatic condition. Allowing and experiencing crying, sobbing  and all natural expressions of grief as they naturally occur will help Hannah psychologically whether related to her asthma or not.
Danny — Headaches have many origins and I’m glad your wife is under a physician’s care to help her deal with them. If she has experienced traumatic experiences or accumulated smaller resentments or fears, it may also be helpful for her to talk to a counselor. The psychological component of headaches can derive from any difficult or negative emotion, but some professional psychotherapists believe it is often related to anger that is either present or repressed. The muscles in the head, neck, and shoulders are often referred to as the “aggression cap”; these are the muscles that tense up to hold back the impulse to hit, punch, bite, spit or express angry words. Often these muscles tighten up before the person even experiences any aggressive impulses. If a headache is emotionally related, exploring and acknowledging angry feelings may help reduce chronic tension because the feelings the body is tensing against experiencing and impulsively acting upon are no longer a prevailing force. After the anger and resentment are experienced, the muscles relax and the headaches may be reduced in both quantity and intensity.
Again, it’s important to emphasize that it should not be automatically assumed that physical symptoms are from an emotional source.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her Web site,


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