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"It's in your head" is often true and often offensive. But as your head can invent any number of psychological and physiological symptoms how can you distinguish whether something is or isn't psychosomatic?

My naive stance (which I'm looking to correct) so far is that if the symptoms are too vague or too arbitrary it's psychosomatic. This probably has some indirect legitimacy but is entirely anecdotal. For example something too arbitrary would be: experiencing pain in your feet after standing in water in a shower, but standing in a bathtub, pool, lake, or ocean doesn't cause it.

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    $\begingroup$ From what I've been reading about bipolar disorder, the Person's sensitivity to pain is subject to change. Depression lowers pain threshold, causing the person to feel what was easily ignored before. This causes a number of anxiety- related thoughts to raise about these "new symptoms". - from "bipolar disorder" by F. Mondimore $\endgroup$
    – Alex Stone
    Commented Nov 25, 2012 at 5:11

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I believe 'psychosomatic' describes a way the mind has effects on the your body which might result in somatic symptoms. Often psychosomatic disorders are diagnosed as such when:

  • no somatic correlate to the experienced symptoms can be found
  • somatic correlates do not sufficiently explain the experienced symptoms

This often results in patients who visit different doctors over a longer period of time, desperately looking for a reason for their symptoms.

Also psychosomatic can refer to diseases which have a clear somatic correlate (e.g. Hashimoto-Thyreoiditis) but the cause of the disease is unknown and the symptoms are influenced by your state of mind (e.g. symptoms worsen under stress).

However as medical diagnostic tools are limited, it cannot be excluded that there is really no somatic cause for psychosomatic disorders.

ICD-10 diagnostic criteria for psychosomatic disorders are available online, e.g. for somatization disorder: http://apps.who.int/classifications/icd10/browse/2010/en#/F45.0

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    $\begingroup$ Hashimoto's is recognized as an autoimmune disease, it is definitely not psychosomatic (by your definition, any disease could be exacerbated by stress). $\endgroup$
    – Chuck Sherrington
    Commented Nov 24, 2012 at 1:57
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    $\begingroup$ True! I was referring to the psychosomatic 'seven holy cows' (gastric ulcera, colitis ulcerosa, neurodermatitis, asthma, hypertension, rheumatoid arthritis, thyreoid dysfunction) which is of course a historic classification. All those are under influence of you current state of mind and have clear somatic correlates (e.g. TPO-Antibodies for Hashimoto) but often we do not know where they are coming from. Of course there is no measure regarding how dependent on your state of mind a disease needs to be in order to be classified as psychosomatic. $\endgroup$
    – jokel
    Commented Nov 24, 2012 at 10:46

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