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Stress Illness: The Complete Guide

Updated: Apr 19


This is a comprehensive guide to Stress Illness. It will talk about stress related illnesses, illnesses caused by stress and anxiety, but its primary purpose is to inform the reader about Stress Illness (SI), which is also known as Tension Myositis Syndrome (TMS) or Psychophysiological Disorder (PPD).

In this series of articles, you’ll learn everything you need to know about Stress Illness. Each article will address a different aspect and build to create a useful reference for those wishing to understand more about the complexities of Stress Illnesses. The articles will cover:

1. What is Stress Illness? – It’s history and how it develops.

2. The 5 guiding principles in Stress Illness Recovery.

3. P – Physical Pain - The various forms of pain Stress Illness can take.

4. E – Emotions - The possible causes and pathways of Stress Illness.

5. T- Thoughts - How Stress Illness affects people’s thoughts.

6. A – Actions - How Stress Illness affects people’s behaviours.

- How worry is intrinsically linked to Stress Illness.

7. L – Losses - The losses caused by Stress Illness.

8. The PETAL Plan - The treatment options available to resolve Stress Illness.

This will be created over several weeks through a series of articles. It will use information from my personal and clinical experience, and the current research on Stress Illness and Chronic Pain, from Neuropsychology, Pain Psychology, Neurobiology, Cognitive and Behavioural Psychology and many more.


This is timely as prevalence of stress is increasing worldwide. In a survey by Gallup (2019) it was reported that nearly a third of all those asked claimed to feel stressed, worried, or angry. In 2020, the American Psychological Association reported that 80% of Americans said that the Coronavirus had increased their stress levels.

In the UK, rates of stress induced illnesses in the workplace had been rising prior to CV-19 but escalated substantially in the last 2 years. This can be seen in the diagram below from the Labour Force Survey (LFS)

Rate of work-related Stress, depression or anxiety (new or long-standing) per 100,000 workers in 2020/21

In the recent years prior to the coronavirus pandemic, the rate of self-reported work- related stress, depression or anxiety had shown signs of increasing. In 2020/21 the rate was higher than the 2018/19 pre-coronavirus levels.

No ill health data was collected in 2002/03 and 2012/13, represented by the dashed line.

Shaded area represents a 95% confidence interval Source: LFS annual estimate, from 2001/02 to 2020/21

With an increase of stress, depression, and anxiety comes the increase of physical manifestations of those states.

The last two years have been incredibly uncertain for most people across the world. If these emotional problems become chronic, and the person does not have an internal sense of safety, then these issues risk becoming Stress Illnesses.

There is a vast number of illnesses and health problems that are caused, maintained, or complicated by stress. They are not readily recognized by most people. The severity of the symptoms is also hugely varied. These can range from everyday indigestion and headaches for some. To chronic pain, not being able to walk, high blood pressure, heart attack, and even death in some catastrophic cases. Education and awareness around Stress Illness is essential.

The saddest thing is that many of the symptoms are treatable, and do not even require medication or surgery. There are lots of things you can start to do in daily life to become pain free. But people do not know this. It is my mission to rectify this!


This first article will cover the various names given to Stress Illness; Tension Myositis Syndrome (TMS), Psychophysiological Disorder (PPD) and Mindbody Syndrome. I will start to explore some of the issues with this terminology, the history of Stress Illness, and the proposed causes of the disorder.


Psychophysiological Disorder is the medical term used most in the United States to refer to Stress Illness. It quite literally means

“…physical conditions and pain symptoms in the body that develop in response to stress, trauma, and other psychological factors. These mind-body symptoms can affect almost any structure, organ system or region of the body.” ( Accessed 03/04/2022)

However, medically trained personal may either be unaware of this diagnosis, feel uncomfortable discussing it, or not have the sufficient time to explore the underlying psychosocial causes with the patient.

This means many patients end up being passed between numerous departments and specialists, collecting a list of diagnoses, and facing extended, unnecessary uncertainty. And a sense of not being believed or helped.

As you can see even the name Psychophysiological Disorder can be problematic as it implies those issues start with the psyche. This can be difficult for some people to accept.

However, the fact that psychological stress causes a physical response is something we can all relate to in terms of a headache or indigestion. Chronic Pain and other Stress Illnesses are symptoms of stress.


The original diagnostic term for Stress Illness was Tension Myositis Syndrome. Later Tension Myoneural Syndrome (TMS) and was introduced by John E. Sarno M.D. Dr Sarno was a professor of Rehabilitation Medicine at the New York University School of Medicine. In the early 1970s he started noticing that people with chronic pain did not necessarily have pathological or structural abnormalities. What they did have was other health problems known to be caused by stress, such as IBS, ulcers, and headaches.

After years studying this phenomenon, Sarno, in keeping with the prominent psychological theory at the time, believed that the chronic pain was caused by repressed emotions. Therefore, he believed that by helping people to access these emotions and release them, they could alleviate their pain and other symptoms. He was definitely on the right lines.


It captures both the driving force behind the symptoms (stress) and the physical sensations caused (illness) in a less medicalized and more accessible term.

The term Stress Illness is also used by Georgie Oldfield. Georgie is a Chartered Physiotherapist who back in 2007 had been noticing the inconsistencies of chronic pain recovery. She came across Dr Sarno' s work and met with him in New York. In 2010, she set up SIRPA UK, the Stress Illness Recovery Practitioners Association to train professionals in the methods developed by Sarno to address Chronic Pain/Stress Illness.

This has developed over the years and the original psychodynamic methods now include many Cognitive Behavioural informed exercises for clients to complete. The theory is still heavily psychoanalytic, however.

The ethos at SIRPA is to train practitioners in the Stress Illness work so they may to integrate it into their own professional practice. Using the latest research from Cognitive Behavioural Psychotherapy, Cognitive Neurology, Neurological Biology, and Pain Psychology, Evolve Psychotherapy and Evolve with Tina aim to achieve this synthesis. Combined with personal and clinical experience, the PETAL Plan offers an evidence-based theoretically derived, clinically proven model of Stress Illness recovery.

To understand how this model works, we first need to understand stress, and how it causes the difficulties in Stress Illness.


Traditionally, stress has been described as the physical, emotional, or psychological strain usually caused by change.

However, Peters, McEwen and Friston, (2017;184, accessed online 03/04/2022) propose that stress is “…the individual state of uncertainty about what needs to be done to safeguard physical, mental, or social well-being.” This gives more emphasis to the thoughts about uncertainty in the given situation.

This fits with my clinical observations and my personal experience that change doesn’t cause stress. In fact, many times change can be positive and regarded as such. Yet, if there is a sense of uncontrollability or unpredictability about that change, stress is very much a part of the equation for most, if not all human beings.

Until recently I believed that we perhaps learned to fear uncertainty just as we learn to fear dogs if one was to bite us. However, the Generalized Unsafety Theory of Stress, (Brosschot, Verkuil, & Thayer, 2018) states that we are born with an ‘intolerance of uncertainty’ and a need to learn how to feel safe. This is taught by care givers in those first years of life. If the sense of safety is not learned, then the individual will continue to struggle in situations that are ambiguous in daily life.

We can see that those times of uncertainty can then cause a lack of safety, increase of stress, and thus increases the release of stress related hormones in the body, causing tension and psychological hypervigilance. If that uncertainty is ongoing, as in chronic stress situations (or perceived as ongoing as in Generalised Anxiety Disorder) (or experienced as ongoing as in Post-Traumatic Stress Disorder) then the pain or other Stress Illness symptoms will also continue.


I have introduced the concept of Stress Illness and spoken about the various names it is also known as. I have also spoken about how a new theory of stress proposes that it is caused by not learning how to feel safe in our early years. This then sets us up to be more prone to experience stress when things are uncertain. The result from this is increased cortisol in the body and reduced ability to control stress, which leads to more physical issues known as Stress Illness.

The main message is, however, that this is not a life sentence and chronic pain, and stress illness is curable and over the next few weeks I will be informing you about the many other aspects of this concept and ways to deal with it.

Just by becoming aware that stress can lead to longer-term physical symptoms you have the option to do something different. When we have choice, we have power. Use your power to reduce your potential for pain. By learning how to recognise and reduce your stress, you can take control and reduce uncertainty.

Simple stress reduction techniques include deep relaxed breathing, exercise, imagery, mindfulness, or progressive muscle relaxation. If you would like some guidance, you can download this FREE Calming Techniques Guide.

In the next article I will be exploring the different types of Stress Illnesses and how to recognise if you have any of the symptoms.



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