Breathing Issues: When to Consult a Psychosomatic Specialist

Respiratory issues

Hello Doctor: My symptoms started at the end of February this year.
I have a constant urge to take deep breaths, inhaling and exhaling deeply; if I don't do this, I feel a tightness in my chest.
At that time, my heart rate was very fast (140 bpm during the consultation).
Therefore, I visited both the pulmonology and cardiology departments, where I underwent an electrocardiogram, chest X-ray, blood tests, echocardiogram, and lung perfusion scan, all of which returned normal results.
The doctor advised me to monitor my condition.
My heart rate has since decreased but is still somewhat elevated.
However, my breathing issue has not improved; I feel a strong urge to take deep breaths each time it occurs.
I notice that I am less aware of it when I am focused on tasks or exercising.
When I relax, I become more aware of my breathing, which triggers the sensation.
Throughout the day, sometimes it’s manageable, and other times it’s quite severe.
I researched online and found that I have several issues that resemble autonomic nervous system dysfunction (frequent urges to defecate, constipation, gastroesophageal reflux, chest tightness, palpitations, insomnia, headaches, anxiety, and lack of energy, each to some degree).
However, the breathing issue is currently the most prominent and troubling for me.
After several months, there has been no significant improvement.
I currently have no stress or issues on the psychological front, as I am taking classes at home, which has made things easier.
1.
Given my current symptoms, should I see a psychiatrist, or are there any other tests I need to undergo?
2.
Can medications prescribed by a psychiatrist help resolve my issues?
3.
If I choose not to see a psychiatrist, what lifestyle changes can I make to help improve my situation?
4.
Is it possible that my condition is related to autonomic nervous system dysfunction?

zero one, 10~19 year old female. Ask Date: 2020/08/01

Dr. Huang Xiaoxian reply Psychiatry

Dear Jason, based on your description, it seems to align with the symptoms of psychosomatic disorder.
Most people who become overly focused on their breathing tend to experience an increase in their breathing rate, which can lead to discomfort.
This excessive focus often stems from an anxious state.
Anxiety can also lead to autonomic nervous system dysregulation.
I recommend that you seek an evaluation at a psychosomatic medicine clinic for appropriate medication treatment.
In the meantime, engaging in hobbies that help relieve your stress or discussing your concerns with someone you trust can be beneficial.
Wishing you all the best.

Reply Date: 2020/08/01

More Info

It sounds like you are experiencing significant distress related to your breathing issues, which can be quite concerning. Given the symptoms you've described, it is indeed advisable to consult a psychosomatic specialist or a mental health professional. Here’s a comprehensive response to your questions based on the information provided and general medical knowledge.

1. Should You See a Psychosomatic Specialist?
Yes, based on your symptoms, it would be beneficial to consult a psychosomatic specialist. Your description of persistent breathing issues, feelings of chest tightness, and the need to take deep breaths, especially when you are at rest, suggests that there may be an underlying anxiety or stress-related component. Psychosomatic specialists focus on the interplay between the mind and body, and they can help identify if your symptoms are related to psychological factors. Since you have already undergone various physical examinations (such as ECG, chest X-rays, and echocardiograms) that returned normal results, it’s reasonable to explore the possibility that your symptoms may be psychosomatic in nature.

2. Can Medication Prescribed by a Psychosomatic Specialist Help?
Medications prescribed by a psychosomatic specialist can be effective in managing symptoms related to anxiety and stress. Common medications include selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, which can help reduce anxiety levels and improve overall mood. However, it’s important to have a thorough discussion with your doctor about the potential benefits and side effects of any medication. While medication can alleviate symptoms, it is often most effective when combined with psychotherapy, such as cognitive-behavioral therapy (CBT), which can help address the underlying thought patterns contributing to your anxiety.

3. What Can You Do in Your Daily Life to Help Improve Your Symptoms?
There are several strategies you can implement in your daily life to help manage your symptoms:
- Breathing Exercises: Practice deep breathing techniques, such as diaphragmatic breathing, which can help calm your nervous system and reduce feelings of breathlessness.

- Mindfulness and Meditation: Engaging in mindfulness practices can help you stay present and reduce anxiety about your breathing. Apps like Headspace or Calm can guide you through meditation exercises.

- Regular Physical Activity: Exercise can significantly reduce anxiety and improve your overall mood. Aim for at least 30 minutes of moderate exercise most days of the week.

- Healthy Lifestyle Choices: Ensure you are eating a balanced diet, staying hydrated, and getting enough sleep. Avoid caffeine and alcohol, as they can exacerbate anxiety symptoms.

- Limit Stressors: Identify any potential stressors in your life and work on strategies to manage or eliminate them. This could include setting boundaries with work or social obligations.

4. Could Your Condition Be Related to Autonomic Nervous System Dysfunction?
Yes, your symptoms could be indicative of autonomic nervous system dysfunction, often referred to as dysautonomia. This condition can manifest as a variety of symptoms, including those you mentioned: gastrointestinal issues, anxiety, and respiratory discomfort. The autonomic nervous system regulates involuntary bodily functions, and when it is out of balance, it can lead to a range of physical symptoms. Consulting with a specialist who understands this area can provide you with more targeted treatment options.

In summary, it is advisable to seek help from a psychosomatic specialist who can provide a comprehensive evaluation of your symptoms. Medication may be beneficial, but combining it with lifestyle changes and therapy will likely yield the best results. Remember, you are not alone in this, and seeking help is a strong and positive step towards feeling better.

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