MBS

DIAGNOSIS

Think your symptom may be a manifestation of MBS? Use the protocol that follows to build support for your hypothesis. It’s broken into three steps:

I’ll give you the synopsis up front: If you have a chronic symptom that your doctor can’t adequately explain, it’s likely that you have MBS. Extra points for MBS if (1) your symptom is commonly caused by MBS or has hallmarks of MBS, and (2) you can identify stressors that may have contributed to its development.

Nothing to lose

You can’t know for certain that your symptom is caused by MBS before you start treating it. You might find this fact frustrating, but look at it this way: you have nothing to lose by treating a symptom as if it is caused by MBS (assuming that you aren’t forgoing needed medical care). Even if your symptom does have a physical basis and can’t be cured using MBS treatment methods, you can still use these methods to keep your negative reactions to your symptom in check and prevent them from increasing your suffering.

Step 1: Visit your doctor

MBS experts believe (1) that MBS is highly prevalent, (2) that most chronic pain is psychogenic, and (3) that almost everyone will experience MBS-induced symptoms at some point in their life. However, there are, of course, many medical conditions that are caused by a physical problem in the body and that do require medical treatment. Examples of such conditions include cancer, heart disease, stroke, autoimmune diseases, and infections. Further, many classic MBS symptoms can be caused by a physical problem in certain cases. Thus, it's wise to work with your doctor to rule out any potential physical causes for your symptoms before you dump their ass for a book. 

But be warned: Most doctors are only trained to look for physical problems, and if your only tool is a hammer, every problem looks like a nail. It’s not uncommon for doctors to pin the blame for MBS symptoms on what Dr. John Sarno called “normal abnormalities.” Blaming back pain on aging-induced spinal deformities is a prime example of such misattribution. So get your body checked, but take any inconclusive findings with a grain of salt.   

It’s common for people with MBS to go from doctor to doctor in search of an actionable diagnosis. In some cases, they are told that nothing is wrong with them, while in others, they are diagnosed with a serious, incurable condition. (I’m not sure which is worse.) In either case, if your menagerie of doctors hasn’t been able to identify a physical problem that adequately explains your symptoms and if your symptoms are not responding to conventional treatments, it’s likely that you are dealing with MBS.

Normal abnormalities

Doctors like to pin chronic back pain on structural anomalies, such as degenerative disc disease, bulging discs, and spinal stenosis. However, studies have shown (1) that there is very little correlation between back pain and MRI results (e.g., Borenstein, 2001), (2) that a high proportion of pain-free people have spine degeneration (Brinjikji, 2015), and (3) that less than 1% of people with low back pain have a specific spinal pathology (Bardin, 2017). In other words, there are many people with structural anomalies who have no back pain and many people with no structural anomalies that have severe back pain.

Step 2: Take stock of symptoms

The defining characteristic of MBS symptoms is that they are not caused by a physical problem. Unfortunately, that’s not something that we can confirm with 100% certainty. Thus, to build support for an MBS diagnosis, it can be helpful to consider whether your symptoms (1) have any of the hallmarks of MBS, and/or (2) are classic MBS symptoms.

(1) Hallmarks of MBS:

MBS symptoms have a certain smell to them. They tend to be: 

Inconsistent. They may come and go, fluctuate in severity, and/or spread or jump to different parts of the body. (Pain caused by a physical problem doesn’t vary like this.) 

Tied to stress. They may be noticeably exacerbated by stress and may have first appeared during a stressful time. 

Triggered by innocuous stimuli. You may associate their onset with something harmless, such as a particular activity, movement, position, time of day, weather pattern, food, or smell. 

Multifarious. It’s common for MBS sufferers to experience symptoms in multiple parts of their body and be plagued with multiple different MBS-induced symptoms over the course of their lives.

(2) Examples of classic MBS symptoms:

  • chronic back pain

  • headaches

  • temporomandibular joint (TMJ) disorders

  • tinnitus 

  • whiplash

  • irritable bowel syndrome (IBS)

  • gastroesophageal reflux disease (GERD)

  • interstitial cystitis (IC)

  • vulvodynia

  • tendonitis 

  • repetitive strain injury (RSI)

  • fibromyalgia

  • chronic fatigue syndrome (CFS)

  • paresthesias (numbness, tingling, burning) 

  • hives

  • dizziness

  • brain fog

  • long covid

  • insomnia

  • anxiety/depression

  • obsessive-compulsive disorder (OCD)

  • eating disorders

Step 3: Identify stressors

MBS symptoms tend to pop up during stressful times. Think back to when your symptom first started and try to identify any situations that you were dealing with that could have made your brain feel unsafe. Keep an eye out for situations that were putting pressure on you, causing internal conflict, making you feel trapped or powerless, or inciting other challenging emotions. 

Bear in mind that the stressor that triggered your symptom may: 

  1. Seem insignificant. It need not be dramatic or tragic. It could be a mundane or even positive situation, like a new job. 

  2. Be tied to the past. Experiences that produce strong emotions leave an imprint on us that shapes our emotional reactions later in life. As a result, little stressors can trigger disproportionately large emotional responses if they resemble a previous stressor in some way.

  3. Come from within. MBS sufferers have stressy personalities that put them on constant high alert. They tend to be anxious, perfectionistic, self-critical, overly conscientious, and/or self-sacrificing. They may be plagued by guilt, shame, or unprocessed trauma.