Q&A: Addressing serious medical issues along with typical TMS symptoms

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I have just left hospital after my 5th hypertensive crisis that cannot be explained. Had a perfect annual physical 1 month ago and now am on beta and alpha blockers to steady heart and blood pressure. Have had crippling back pain, migraines, stroke, and nausea separately and together. This time just migraine, nausea and loose stool. I suspect childhood sexual molestation, and know of teen and adult violence, sexual abuse and abandonment. Struggling with drugs the doctors prescribe without support or explanation of symptoms. Should I see Dr. Sarno or try therapy alone, again?

Answer by Howard Schubiner, MD

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Howard Schubiner, MD

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Your question brings up several important issues which are important to address. It is critical to distinguish medical conditions and symptoms that are caused by TMS from those that are not. I am always very careful to distinguish between the two as best as I can, although I recognize that it is sometimes difficult to determine if certain symptoms are caused by TMS or not. You should also understand that different TMS doctors may disagree about whether a specific symptom is caused by TMS or not. I generally divide disorders into those that are clearly TMS (i.e. have no tissue breakdown in the body), such as the vast majority of people with headaches, most people with back pain (as long as there is no objective evidence of nerve damage), and all of those folks with fibromyalgia and irritable bowel syndrome; those that are clearly not TMS (clear evidence of tissue breakdown and disorders that increase with age), such as cancer, heart disease and stroke; and those that are somewhat in the middle (i.e. disorders with some tissue breakdown, but also appear to be significantly influenced by the mind), such as rheumatoid arthritis, asthma, and ulcerative colitis.

High blood pressure can be caused by many physical conditions in the body, but most people with high blood pressure do not have one of these conditions. While high blood pressure does increase with age, there are many reports suggesting that high blood pressure in some people may be related to stress and emotional distress.

Therefore, with regard to your specific questions, I would not consider a stroke to be caused by TMS and since the episodes of high blood pressure can cause significant physical disorders, I would suggest seeking good medical care to look for an underlying medical condition for the hypertensive emergencies and find the right medications to prevent future episodes. The migraine headaches and the GI symptoms are typical of TMS and if your doctor has not found an underlying cause for these after the appropriate amount of testing, it would make prefect sense to deal with these symptoms as manifestations of TMS.

Having said all that, how you choose to deal with TMS is your next decision. Once again, I'm assuming that you have seen your regular doctor for the stroke and high blood pressure treatment and to rule out any underlying medical condition causing headaches and GI symptoms. Some people find that they really need to see a TMS physician who can give them assurance that they really do have TMS. It is critical to know that you are dealing with TMS in order to improve the odds of a quick recovery. Some people don't need a TMS doctor because they can be certain about having TMS based upon their symptoms, their medical testing, and their knowledge of their life stressors. You need to decide if you need a visit or consultation with a TMS doctor. Unfortunately, there are not enough of us right now.

Finally, you will need to decide what kind of TMS treatment to engage in. Your options include reading books and following those programs, participating in online programs, or seeking help from a therapist. If one of those options has worked in the past for you, I would suggest trying that again. The TMS Wiki and the TMS Help Forum can be invaluable sources of information as well.


It is important to recognize that no information on this wiki can be considered a specific medical diagnosis, medical treatment, or medical advice. Reading information here does not create a doctor/patient or other professional relationship between you and the answering professional. As always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.

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