Many people notice physical symptoms such as a tightness in the throat, difficulty swallowing, and changes in the tongue or in the mouth area (e.g., pulling and pain) that cause them great worry. If a thorough examination conducted by a primary physician did not yield an indication of an organic (=physical) cause (e.g., thyroid enlargement) and if it was also possible to rule out a cause in the nasopharynx such as a nerve disease, then a psychological cause of the symptoms should be considered. In such cases, psychiatrists and psychologists speak of a so-called "somatoform disorder." This term refers to physically perceived symptoms in various places of the body, which cannot be traced to any impairment or damage (e.g., inflammation, tumor, etc.) of an organ located in those places. Rather, an etiological explanation for these symptoms is functional disorders of the so-called autonomous nervous system related to stress, strains, or very often depression or generalized fears. Colloquially, we often speak of people having a "lump in their throat" or "having something stuck in their throat" when we want to refer to someone being in a difficult situation, for which their does not seem to be a solution or a verbal answer Many people, who are depressed, report feeling such a lump in their throat. In medical jargon, this feeling is also referred to as a "globus sensation." A characteristic of such psychologically correlated symptoms is a "vicious circle," which seems to contribute to increasingly stronger symptoms:

• In a generally tense or stressful situation (e.g., personal or job-related heavy burden, separation, worries), an individual first notices a physical symptom.

• This symptom along with others are then increasingly observed although they may first occur every once in a while without being able to find a personal explanation for their occurrence.

• Next, the individual visits his personal physician. However, the physician also reports "no findings." Just to be "sure," the individual is then sent to a specialist.

  Despite extensive examinations (and, where necessary, further examinations conducted by one or more other specialists), the physicians are still unable to find an explanation for the individual's symptoms and say that everything is fine.

• For a short time, the individual may feel relieved. But then, all of a sudden the symptoms return!

• This is when panic may set in. The individual now starts to pay more attention to the symptoms and becomes stressed upon noticing even the slightest change in his body.

• In addition, he starts to have thoughts that only increase the stress. These thoughts can lead to fears of having a tumor or strange disease. (These thoughts are, of course, completely unfounded!)

• All of this generates inner tension and a stress reaction in the body, thereby activating a range of bodily functions as well as triggering muscular tension. The individual perhaps notices an accelerated and seemingly irregular heartbeat, sweating or other physical symptoms of stress.

  There is now an increased awareness of these symptoms, and to a certain extent, the individual sees them as being a confirmation of a disease or illness.

  And so the vicious circle closes.

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