This is a frustrating yet common occurrence for people who are healing from MBS.

You may fully accept the MBS diagnosis while continuing to struggle with repressed emotions, unresolved grief, chronic self-criticism, relationship conflict, perfectionism, guilt, shame, or other pressures that caused your symptoms in the first place.

Additionally, fear and obsessive thoughts are very effective at maintaining MBS symptoms, even for those who intellectually accept their pain is not structural in nature.

Our brains are hardwired to be constantly making predictions. Modern pain research shows that when the brain expects pain, it often produces the very symptom it is anticipating.

As a result, if you struggle with MBS you likely find yourself stuck in a vicious cycle: your thoughts become obsessed with pain and your nervous system keeps delivering on this self-fulfilling prophecy.

Dr. John Sarno believed this obsession with symptoms serves a defensive function. According to Dr. Sarno, the more your attention becomes focused on your pain, the more distracted you become from emotions and thoughts that feel at odds with how you want to see yourself and be seen by others.  

Even if it takes longer than you would prefer, consistently addressing the root causes of your pain and disrupting the cycle of fear and symptom obsession is how healing occurs.

Pain that moves from one location to another is a hallmark of MBS.

A classic example would be new pain flaring up in another part of the body after back pain improves.

People can also experience symptoms like gastrointestinal distress, migraines, and rashes once pain resolves. 

Dr. Sarno referred to this phenomenon as the Symptom Imperative. He observed that when a symptom loses its ability to capture your attention and create fear, the underlying process that produced it can still remain active. As a result, symptoms may reappear in a different form or location.

The goal of depth-oriented therapy for MBS is to do more than eliminate a particular symptom. The goal is to understand and resolve the unconscious emotional conflicts that made your symptoms necessary in the first place. Otherwise, your pain may resolve in one area only to reappear somewhere else.

A new symptom flaring up after another resolves is often discouraging. However, it can also provide a silver lining.

Recognizing the Symptom Imperative as it operates in real time may strengthen your confidence that your symptoms are being produced by your unconscious mind.

Many people find this realization helps weaken the cycle of fear that keeps them obsessed with their symptoms.

When doctors can’t find a clear structural cause for your pain it can feel like you’ve hit a dead end. 

This is especially common if you’ve been diagnosed with conditions such as fibromyalgia, irritable bowel syndrome (IBS), chronic fatigue syndrome, and migraine.

It is depressing to be told your best treatment option is symptom management and that true healing is likely an unrealistic expectation. 

Viewing chronic symptoms through the lens of MBS offers a new path forward. 

Rather than concentrate on begrudging acceptance and restricting your life to accommodate your symptoms, depth-oriented MBS therapy attempts to resolve your unconscious conflicts and heal the emotional wounds that produce your physical symptoms. 

MBS also provides an explanation for many forms of back, neck, and pelvic pain that lack a clear structural cause, as well as conditions such as Temporomandibular Joint Disorder (TMJ) and Complex Regional Pain Syndrome (CRPS).

Serious medical conditions should always be ruled out through appropriate medical evaluation.

However, those who seek treatment for MBS often do so after medical tests fail to provide a clear structural explanation for their pain.

Yes. Mind Body Syndrome produces real, physical pain. 

A common misconception about MBS is that it implies your symptoms are imaginary, exaggerated, or “all in your head.” This could not be further from the truth. 

Pain caused by MBS is every bit as real as pain caused by a broken bone, infection, or other medical condition.

To better understand why, it is helpful to consider where our experience of pain begins. Pain is produced by our brains and nervous systems as a means of alerting us to injury or danger. 

However, the brain can also generate pain and cause distressing physical symptoms in the absence of ongoing tissue damage, especially when it is responding to an emotional injury or a perceived threat to your sense of self. 

You might recognize this phenomenon in other areas of your life. Have you ever experienced an upset stomach before an important event, a racing heart when feeling anxious, blushing when you are embarrassed, or tension headaches during periods of stress? 

In each of these examples, your thoughts and emotions produce genuine physical changes in your body. 

MBS extends this same principle to chronic pain and other persistent symptoms. 

Unconscious conflicts, emotional pain, trauma, stress, and fear can all trigger your brain to send signals that produce real physical pain.

As a depth oriented MBS therapist I strongly believe your pain is not random and it is not imaginary. It is meaningful. As psychologist Larry Leitner observed, symptoms are often "a message to yourself, from yourself, about yourself."

This principle holds just as true for physical symptoms caused by MBS as it does psychological symptoms such as anxiety and depression. 

Many people who have made a full recovery from back, neck, and shoulder pain caused by MBS have received MRIs that showed herniated discs and other degenerative changes.

This begs the question: How could someone whose MRI shows a degenerative abnormality recover from back pain simply by changing how they think about their pain and processing difficult emotions?

Part of the answer lies in the fact that there is not always a causal relationship between imaging findings and the experience of chronic pain.

MRI findings such as herniated discs, bulging discs, degenerative disc disease, and rotator cuff tears are frequently found in people who have no pain at all.

Conversely, many people experience severe chronic pain despite relatively minor findings on imaging.

Doctors who treat MBS point out that structural abnormalities and pain do not always correlate the way we assume they do.

Identifying an abnormality on an MRI doesn’t necessarily tell us what is causing chronic pain.

Many who have healed from pain caused by MBS despite being diagnosed with a herniated disc did so after accepting that repressed emotions, unconscious conflicts, fear, and other psychological processes were responsible for their symptoms.

I should know, because I was diagnosed with a herniated disc at age 18 and told I would likely have to manage it for the rest of my life.

However, I made a complete recovery after discovering Dr. Sarno's work. You can read more about my story here.

I encourage clients to obtain appropriate medical evaluation so that serious medical conditions are not overlooked. Conditions such as cancer, tumors, infections, fractures, and other medical illnesses can cause pain and should be ruled out before considering an MBS diagnosis.

Yes. Stress can cause real physical symptoms, including chronic pain.

Have you ever experienced anxiety that caused your heart to race, muscles to tighten, or your stomach to churn?

This is an example of how your brain can react to a psychological stressor by producing physical changes in your body.

Stressful life events often generate powerful emotions such as anger, fear, grief, shame, disappointment, guilt, resentment, and feelings of inadequacy. 

People with MBS frequntly struggle to acknowledge these emotions directly.

Instead, they push them aside, minimize them, or remain unaware of them altogether.

According to Dr. Sarno, the repression of anger is one of the primary causes of MBS symptoms.

Dr. Sarno believed that stress causes pain not simply because it creates tension, but because it stirs up emotions the mind is attempting to keep out of awareness. 

When these emotions intensify, symptoms often intensify as well.

This is why pain frequently becomes worse during periods of relationship conflict, financial strain, work stress, grief, major life transitions, or other emotionally significant events. 

More often than not, flare-ups aren’t random. They are like a canary in a coal mine, indicating that something important is happening in your unconscious.

When symptoms worsen, it can be helpful to heed Dr. Sarno’s advice to “think psychologically” and examine what has been happening in your life.

Is there anything going on that is causing an increase in stress? If so, what emotions do those circumstances bring up? 

The answers to those questions may provide important clues about why your symptoms appeared in the first place.

On the surface the answer to this question appears to be fairly straightforward: if your chronic pain makes you miserable all the time, why wouldn’t you think about it constantly?

It’s difficult to ignore a person who is screaming in your ear, and chronic pain can be like an obnoxious loudmouth who won’t stop yelling at you and demanding your attention. 

As a result, you might find yourself monitoring your pain throughout the day, experiencing anxiety when you encounter known triggers, worrying that things might get worse, and repeatedly searching for solutions to make the pain go away. 

Eventually you become obsessed with your pain. It’s the first thing you think about in the morning and the last thing on your mind as you fall asleep at night. 

Dr. Sarno identified a deeper psychological function at work with this obsession.

In fact, he believed it was the primary reason the unconscious mind causes the nervous system to produce chronic pain in the first place : the more attention we focus on physical pain, the less attention we have available for unresolved conflicts, uncomfortable emotions, difficulties in our relationships, and painful memories.

This creates a vicious cycle:

• Your pain generates fear

• Your fear focuses your attention on your symptoms

• Focusing your attention on your symptoms generates even more pain

To disrupt this cycle and recover from MBS, it is often necessary to do more than simply intellectually convince yourself that your pain is not structural.

True healing involves learning to shift your attention away from symptoms and toward the conflicts, emotions, relationship issues, and life circumstances MBS symptoms are there to distract you from.

Many people with chronic pain place enormous pressure on themselves. 

Are you someone who holds yourself to high standards? Maybe you are eager to win approval from others, avoid conflict at all costs, and strive to be a good person?  

Or perhaps you beat yourself up when you make mistakes? 

If you are a perfectionist, you’re probably all too aware of how your inner monologue doesn’t hesitate to inflict emotional pain on you if it thinks that’s what will motivate you to do better. 

MBS extends this same concept to the unconscious mind. Just as your inner critic may inflict emotional pain in the service of self-improvement, your unconscious may produce physical symptoms when thoughts and emotions feel threatening to your sense of what it means to be a good person.

Do you feel guilty for having needs of your own? Uncomfortable asserting yourself? Ashamed of thoughts and emotions you believe you shouldn't have?

Over time, guilt, shame, and a desire to be good can create a gap between how you feel inside and how you believe you are supposed to feel.

The larger that gap becomes, the more psychological energy is required to maintain it.

Anger must be suppressed. Disappointment must be hidden. Resentment must be denied. Vulnerability must be covered over with competence, achievement, or self-control.

Dr. Sarno believed these disowned emotions don’t simply disappear.

Instead, they continue to exert pressure outside of conscious awareness. 

Chronic pain is one way the mind attempts to manage this internal conflict.

When anger, disappointment, resentment, and other difficult emotions can be acknowledged and expressed rather than turned inward, the need for symptoms often begins to diminish.

The less energy devoted to keeping difficult emotions out of awareness, the less need there is for chronic pain and other symptoms.

These terms are related, but they emphasize different aspects of the same process.

Psychogenic pain refers to pain that is generated or amplified by psychological and emotional processes rather than ongoing tissue damage.

Psychosomatic pain highlights the connection between mind and body, recognizing that emotional stress, unresolved conflict, fear, trauma, and nervous system activation can produce real physical symptoms.

Neuroplastic pain is a newer term that focuses on the brain and nervous system's ability to learn and perpetuate pain pathways even after an injury has healed or when no structural cause can fully explain the severity of symptoms.

While these terms come from different traditions, they all point toward the same central idea: pain can be very real, very physical, and very distressing even when it is being generated by unconscious conflicts and learned patterns within the nervous system rather than ongoing injury or disease.

Feeling angry when you first encounter the idea of MBS is an understandable, and not uncommon, reaction.

For many people, MBS challenges years of medical explanations, treatments, and deeply held beliefs about the body.

Others worry they are being told their pain is imaginary, exaggerated, or "all in their head."

Given those concerns, skepticism, frustration, and even outright anger make sense.

At the same time, Dr. Sarno identified repressed anger as one of the most common contributors to MBS symptoms.

Ironically, sometimes the diagnosis itself can become a target for the very emotion it is attempting to bring into awareness.

For some people, anger toward MBS also serves a psychological function.

First, it provides a safe and seemingly justified target for the expression of an emotion that has long been feared, suppressed, or avoided.

Second, it protects an existing understanding of symptoms that may have become deeply ingrained over many years.

Letting go of a familiar explanation can feel threatening, even when that explanation has failed to produce lasting relief.

In many cases, anger itself is also an important clue to the emotional conflicts underlying the pain.