Observations from my practice and some approaches to managing this
The simple answer is yes. Stress related symptoms are common during “normal” times so in this period of heightened global uncertainty, it is not surprising that General Practitioners such as myself are seeing more patients presenting with symptoms that don’t have a clearly defined physical cause.
By physical cause, we mean that as far as we can tell through careful history and examination and appropriate testing, there isn’t an obvious disease process such as cancer, inflammation or a fracture at the root of the symptoms. Over the last few weeks, we’ve seen more cases of migraine, irritable bowel with normal investigations and unexplained rashes and skin problems. The other presentations that are interesting are those such as eczema and skin problems such as psoriasis which typically don’t affect the patient under normal circumstances.
I’ve certainly has conversations with people who have experienced flare ups of skin conditions that that had not bothered them for years. One patient had a particularly spectacular flare up of psoriasis with a forty year gap between presentations. The last presentation being at the time of his A-Levels in the late 1970s
The interesting question here is why should these sorts of things flare up now? When I spoke to the individual concerned, the current pandemic had brought up feelings of anxiety relating to his job and future and this was similar to the stresses he had experienced during his time at sixth form. It was as if the body had remembered the stress response and churned it out again.
There are many conditions that are thought to have stress-related components. The following list from the PPD Association gives a comprehensive summary (1). So if you are having new symptoms that seem to have started in the last couple of months, what should you do? See below for some thoughts
Firstly any new symptom that is not resolving within reasonable timeframe such as couple of weeks should have a medical evaluation to rule out a physical disease process. Clearly if you feel unwell, then seek help as soon as possible. Any COVID-19 sounding symptom should be managed according to the current guidance which can be found online (2).
Your local GP remains open although there are changes to the operating procedures of all practices. A recent article in the Guardian (3) found that 75% of consultations are now being conducted over the telephone or via video or email. This seems to be working well. Some people will still need to be seen face to face and practices have put in place measures to keep things as safe as possible. This may mean coming to the surgery early on in the day and both doctors’ and patients’ wearing PPE. The hospitals have postponed a lot of routine work but they are still carrying out urgent appointments and essential investigations.
Download the hidden stress test and complete it. This can be found on the PPD website (4). It is not uncommon to find that stressors are not immediately obvious. A person may know that something is stressful intellectually but not be able to connect with the feeling tone of the experience. Interestingly often when people do get in touch with the feelings and “feel” them, the physical symptoms will often resolve. Being stressed about something doesn’t always imply that you are not coping with it.
Once you have the test completed, look carefully at the sources of stress and see if there is anything that you can do to reduce the stress or perhaps alter the way that you are reacting to it. Be gentle with yourself. A spirit of curiosity and self-compassion is helpful. Reduce your expectations of yourself if possible. You do not have to do everything perfectly.
Make time to connect with others. Humans are social creatures and it can be really helpful to talk to others about what is going on – “A problem shared is a problem halved”. This may be in person or virtually. The Smart Brief article below has some helpful suggestions and science (5).
Spend time in nature. Having our “time outside” curtailed in the initial stages of the lockdown made going outside for a “walk” a much bigger thing. It forced us to slow down and explore new routes out of the house. We noticed many things about our local area that we had never actually seen before. This article from the Guardian enthuses the benefits of immersing ourselves in nature which in itself is stress-relievng (6).