Headaches and Medically Unexplained Symptoms

Headaches and Pain

Dr. Eva Fisher D. Ed., C. Psych

It’s upsetting to go to your family doctor for help with headaches, or any pain, and to be told that there is no obvious cause or medical reason for them. You might consider seeing another doctor, only to hear similar conclusions.  Since the headache (or pain) feels real, why can’t doctors find a “real” cause or fix for it?

The fact is that psychological pain can feel just as real as physiological pain, only the cause cannot be found by standard medical testing such as X-ray/MRI or other imaging technologies. It can be additionally frustrating that in many cases, pain medications help little, if at all.

If you are  provided with a referral to a psychologist with training in psychotherapy for medically unexplained symptoms, you may have found new hope for a solution.

A new field of treatment, called Intensive Short Term Dynamic Psychotherapy, or ISTDP, is re-visiting the relationship between emotion suppression and pain. Psychiatrists working in this area have determined that psychological or emotional issues may indeed be implicated in symptoms of headaches, as well as back pain and digestive disorders.

If you or someone you know suffers from unexplained medical symptoms, it may be helpful to schedule an appointment with a psychologist with training in ISTDP.

Dr Eva Fisher is a clinical psychologist with ISTDP training, in private practice located at 436 Gilmour St., Ottawa, Ontario, Canada.

Post-traumatic Stress Disorder

Cory, a veteran police officer, draws his gun just as a bullet whizzes through his hair, grazing his scalp.

Emma, a bank employee freezes when a gunman holds her hostage for several hours in the safe room.

Anthony, a military officer in Afghanistan, runs through crossfire to retrieve the corpses of his buddies.


These images are all too familiar to TV audiences, but nothing can simulate a near-death experience like the ones described by Cory, Emma and Anthony.

They all suffer from Post Traumatic Stress Disorder.

Posttraumatic Stress Disorder (PTSD) occurs after someone is exposed to a life-threatening traumatic event. Commonly this happens after coming back from a war zone, but it can happen after any traumatic or life-threatening event.

Although many people experience very disturbing things in war or security situations, not everyone will develop PTSD. Both the Canadian Department of National Defence, and the United States Department of Veterans Affairs that 11 to 24 percent of veterans from the Iraq and Afghanistan wars have PTSD.

The prevalence of PTSD in the general population is about 7 to 8 per cent.

What are the signs?

Fight or flight is an instinctual human reaction in the face of extreme danger, when you have milliseconds to decide whether to run away to safety or to fight to defend yourself. After a traumatic event, this ”flight or fight” reaction in the body is damaged and the person freezes up when sensations, images, or feelings they had at that time recur in the here and now.

Physiological signs of fear, like rapid heartbeat and profuse sweating activate emotions of acute fear and strong normal responses to threatening situations often appear in PTSD sufferers in situations where there is no danger present.

PTSD usually develops within three months of the traumatic event, but can occur much later in life.


Some of these symptoms are referred to as Re-experiencing symptoms. These include flashbacks of the event, which can bring extreme stress on not only the mind, but also the body in terms of sweating or a racing heart. Bad dreams and frightening thoughts are also typical. The traumas from the past become torturous again, in the present.

Avoiding Triggers

The next category is Avoidance symptoms. This is when the sufferer goes to extremes to avoid reminders of the traumatic event. This can cause people to change their clothing, hair, and even to quit their job to avoid things that trigger memories and to have deep feelings of shame or guilt.


The last category of symptoms is called Hyper-arousal symptoms. This is when a PTSD sufferer becomes very easily stressed or fearful for their safety, such as checking that doors and windows are locked, feeling suspicious of parked cars, strangers and anything they used to consider benign.  This effect of being easily startled can also lead to angry outbursts, constant vigilance for possible signs of danger, and difficulty falling asleep or staying asleep. These symptoms make people more vulnerable to overuse of drugs and alcohol.


Unfortunately there is still a stigma surrounding PTSD. Because it can be such a terrifying and disruptive mental state, sufferers can be labeled as “crazy,” “dangerous,” or “violent.” Other stigmas are general beliefs that since in today’s wars people chose to go to combat, in a sense they brought it on themselves.

Many PTSD sufferers reported that they avoided early treatment because they did not want to be considered to have a mental illness. However, PTSD can be cured through different forms of therapy.

Group treatment programs for PSTD are delivered over 6 to 12 weeks, while individual therapy is customized to each person’s needs.

What happened to them?

Cory was in psychotherapy for 11 months, and eventually retired from the force  to work as an investment advisor. He sometimes remembers the trauma, but can now deal with stressful feelings realistically.

Emma was off work for six months before she was able to step foot in the bank again.  With the help of a psychologist, she eventually felt strong enough to return to her job.

Anthony was released from the military after intensive individual and group psychotherapy.  He still has survivor guilt. He works part-time as a security guard.     

A psychologist can help you learn more about PTSD and its effects, deal with explosive anger, and help you become aware of the signs leading to a recurrence.

If you or someone you know is struggling with post traumatic stress it would be a good idea to schedule an appointment with a registered psychologist.


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisherFacebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.
Photo Credits: Oscar in
the middle Alan

Growing Concerns: Mental Health of University Students

Warren was nervous in the car on the way home from the airport after being kicked out of university.

Warren could tell his dad was furious. The silence, the set of his jaw, the way he drove the car faster than usual all the way home. He didn’t need his dad to remind him  how much it had cost to send him to college with all expenses paid for three years and to come home with few credits and a transcript full of “failed” and “incomplete”.   

Warren knew that he had messed up big time skipping classes, sleeping until noon, drinking, taking drugs and partying. After his girlfriend broke up with him he hadn’t cared much about anything except getting blotto.  He had tried to commit suicide, but he never was good at making knots and the rope wouldn’t hold.  He felt he never had been much good at anything anyway.

If Warren had known that he was in a serious depression soon after beginning first year, he might have been able to get help and get back on track.  He was too ashamed to talk to anyone. The university counseling center was in a dingy building where anyone could see you going in and would know why you were there.  He was embarrassed to ask for help or talk to anyone and that’s how alcohol and drugs became his best friends at university.

The Warrens who burn out at university come from all walks of life.

Nine-five percent of college counseling center directors said the number of students in 2013 with significant psychological problems is a burgeoning concern.  Seventy-five percent believe that the numbers of students with severe psychological problems on campus has increased and continues to climb. The reality is:

-anxiety is the most frequent presenting problem among college students, followed by depression and relationship problems
-one quarter of students take psychotropic medications, directors report the availability of psychiatric services on campus is inadequate
-directors report that 21 percent of counseling center students present with severe mental health issues, and
40% of student present with transient mental health concerns

Most students begin university at a time of life when they are most vulnerable to mental health issues. University-aged people are most likely to suffer from mental illnesses, substance abuse and suicidal behaviors.

An increased awareness of these mental health issues among students is leading to greater pressure for increased funding for campus counseling centers to hire more psychiatrists and case managers to track treatment referrals.

Some forward thinking universities are collaborating for better outreach to students with innovative programs such as stress management workshops, focus programs on mental health issues of students with disabilities, and reward incentives for good ideas for improvement in campus mental health programs.

University students need to be made aware of early signs of burnout, depression and anxiety overload; and universities are ideal environments for effective information exchange. All of these changes will make a large improvement in time.  But they are not prevalent or well understood by students.

If you are a college student who has become unusually withdrawn or unhappy, or if you know another student like that, it is important to talk to them, talk to their friends about it, and ask for help from the student counseling center.

You could also offer to go with them to a psychologist, at least to help them get through the first important visit.


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisher, Facebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.


Student mental health: secondary education no more. By Eileen M. O’Connor Monitor Staff.Sept. 2001, Vol 32, No 8

Data indicate rise in student mental health problems. September 2001, Vol 32, No 8 American Psychological Association

College students exhitibing more severe mental illness, study finds. August 12, 2010. American Psychological Association.

College students’ mental health is a growing concern, survey finds. June 2013, Vol. 44, No 6. American Psychological Association.

photo credit: taberandrew
via photopin

Depression and Insomnia

Insomnia Cure and Success of Depression Treatment

WebMD News from HealthDay
One additional hour of shuteye reduced depressive

By Margaret Steel

HealthDay Reporter

TUESDAY, Nov. 19, 2013 (HealthDay News) — Treating persistent insomnia at the same time as depression could double the chances that the mood disorder will disappear, a new study shows.

Doctors have long reported a link between insomnia — the inability to sleep — and depression, but many thought that depression led to insomnia. Now, experts suspect sleep problems can sometimes precede depression.

If other ongoing studies confirm these results, it might lead to major changes in depression treatment, experts added. Such changes would represent the biggest advance in depression treatment since the antidepressant Prozac was introduced in 1987, The New York Times

Sleep and the river of forgetting

In ancient Greek times, insomniacs appealed to Hypnos, the god of sleep, to bring them to Lethe, the river of forgetting.  The river Lethe was also the river of oblivion, where people drank from the water to forget their earthly existence.

Many insomniacs would welcome such oblivion for the sake of a good night’s sleep. The problem with insomnia is essentially about being unable to forget your conscious concerns for a while.  When your mind is too alert, too full of thoughts, it can’t shut down, and you can’t sleep.  Most people can get through the next day after they have slept poorly, but no one can function normally after several days of sleeplessness or fitful sleep.


Dreams: windows into your unconcious

If you dream that your plane will crash, do you change your flight schedule? If you dream about that good looking person at the office, do you expect them to ask you out?

If you answered yes to either question you are in good company, but perhaps a few centuries behind the times. Ancient civilizations believed that dreams foretold the future, and some primitive cultures believed that a person who appears in your dream is romantically interested in you.


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