When all the tests are normal

So, after months of experiencing nausea, abdominal pain, difficulty eating and listening to your family members harassing you to “just go see someone about it”, you finally bit the bullet and made the appointment with a GI doctor. You survived the dreaded physical examination and are now awaiting the results of your blood tests to rule out any number of clinical issues. You finally get the call that the bloodwork is fine, but you tell the doctor “I’m still feeling terrible!” So your doctor says well let’s go ahead with the endoscopy and see what that shows and you feel a glimmer of hope exists. This will definitely give you the answer to your mystery illness! But nope, everything is still normal so your doctor says “Ok, let’s go for the colonoscopy.” You take a day off from work, barely make it through the prep and the procedure (which really isn’t that bad) and the results, again, come back totally normal. The doctor reports that there is nothing else he or she can do. While you should feel relief that everything is OK, after months of testing and follow-up appointments you still feel terrible and now frustrated and maybe even angry. “The doctor must be missing something, right?!? I must have some rare disease that they have never heard of before.” The answer is probably not. Perhaps, when all the medical factors have been ruled out it may be time to take a step back and explore another part of your body.

The connection between the mind and body is undeniable. When you are experiencing joy or excitement you may describe the feeling as butterflies in your stomach, or when something terrible happens you may feel like you’re going to throw up. Often the symptoms of anxiety mimic or overlap with the symptoms of GI disorders. Fatigue, nausea, diarrhea, constipation, and loss of appetite may be symptoms of irritable bowel syndrome (IBS) or symptoms of anxiety. You may be thinking, “But I don’t have an anxiety problem, I just want to know what’s wrong with my stomach. It’s not all in my head!” The truth is, often the classic anxiety symptoms are absent or at least not as obvious as the GI symptoms. In fact, the National Institute of Mental Health has estimated that in any given year 58 million adults in the United States experience an anxiety disorder, with women being 60% more likely than men to be diagnosed over their lifetime. So don’t discount this common cause of gastrointestinal distress without some careful introspection first.

Although there is no blood test or medical procedure to rule out anxiety, the following tools may be useful in helping you identify existing stressors in your life as well as how to manage the uncomfortable symptoms you are experiencing:

• Write it down. What we think affects how we feel, and how we behave: This is known as the cognitive-behavioral model. One of the first things I encourage people who are experiencing high-levels of stress to do is start writing as a means of organizing your thoughts and collecting information. Just as a dietitian or nutritionist would have you keep a food journal to identify dietary patterns and foods that trigger certain physical reactions, writing down what you are thinking and feeling can help identify negative thought patterns as well as common sources of stress. When we are experiencing distressing symptoms it can feel like it’s happening all the time with no known beginning or end; however, once we become more mindful of our thoughts and feelings we are better able to identify triggers and our responses to those triggers.

• Think positively. Ok, I know…easier said than done. When people tell you to think positively, it’s like saying “Don’t worry about that!” Usually the opposite happens and all you can do is worry or think about that particular thing, making your stress levels skyrocket. However, there is something to be said for positive thinking and reframing negative thoughts. As I mentioned above, our thoughts, feelings, and behaviors are interconnected so by reframing our negative thoughts into positive ones we can change the way we feel and act in a given situation. For example, let’s say you have to give a presentation for the first time at work and you think, “I’ve never done this before, I hope I don’t sound stupid.” This increases your level of stress. Replacing that with a positive thought, such as “this will be a great opportunity to share all I know with my peers” helps you to focus on the possible positive outcomes rather than the negative ones.

• Just relax! Relaxation is not something that comes naturally to everyone, especially if you have significant stressors in your life. Maybe you are a police officer dealing with life and death situations every day at work or you are a single mother who just lost her job. How are you supposed to relax? When practiced daily, relaxation techniques, such as progressive muscle relaxation, are extremely helpful in managing stress. Progressive muscle relaxation is a systematic exercise in which you tense and relax various muscle groups while focusing on controlled breathing. There are many excellent videos available that can help walk you through these exercises.

• Talk about it. Research has found that reaching out to your social network for support during stressful times may serve to mediate the level of anxiety experienced. Social support comes in many forms and through many people. Whether it be close family and friends, co-workers, or joining an actual support group, connecting with others is a powerful tool with important health benefits including decreased stress levels, increased feelings of belonging, and increased self-worth.

• Seek out professional help. “I’ve been to all the real doctors and they said I’m fine. What good is laying on a couch talking about my feelings going to do?” The field of psychology is one that many people are fascinated by, but at the same time don’t fully understand. What we are not familiar with can be scary, but experiencing physical symptoms that are interfering with your daily functioning and have no known medical cause can be even scarier. There are many different branches of psychology, but consulting with a psychologist who practices cognitive behavioral therapy (CBT) is an excellent first step. CBT is comprised of a variety of evidence-based therapies, meaning it is well-researched and proven to be effective in treating a number of disorders including anxiety, depression, substance abuse, and post-traumatic stress disorder (PTSD) to name a few. Sessions are structured, goal-oriented and focused on solving the problem you are currently experiencing. Exercises are assigned between sessions and the therapeutic relationship is supportive and collaborative. Most insurance plans have psychologists in-network who specialize in CBT and allot a certain number of sessions per year. You may search for a provider here.

About Noreen Vail-Gandolfo, PhD

Dr. Noreen Vail-Gandolfo received her doctoral degree in school and clinical psychology from Hofstra University. She is a licensed psychologist and a certified school psychologist in New York State. Dr. Vail-Gandolfo currently works as a school psychologist and behavior consultant in Long Island, NY.