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Dr. Andrew Rynne

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Suffering from uneasiness in stomach, vomiting and discomfort after eating. Looking for treatment

Answered by
Dr. Jonas Sundarakumar


Practicing since :2003

Answered : 2190 Questions

Posted on Tue, 18 Dec 2012 in Abdominal Pain
Question: Hello sir,
My would be wife is suffering from uneasiness in stomach, vomiting and discomfort after eating from almost 1.5 yrs. We had to hospitalize her almost 15 times for this same issue. At first doctors suspecting gastric problem and perform Endoscopy. But nothing major found in this test. Then they suggested us that she may have psychiatric problem and it is nothing but psychiatric vomiting. She is having some problem of anxiety, depression, excessive tension regarding her parents, study and her career too. So we have started psychiatric treatment under that doctor. But she is having same problem once or twice in every month. Whenever she was getting hospitalized, doctor had to start providing her saline and in 3 or 4 days she recovered from that. But in this month for almost 15 days she is not being able to eat, whenever she is eating she is feeling that uneasiness and vomiting some time. Also she is feeling low in self confidence. Doctors are telling she is having psychiatric problem and nothing else. But until this uneasiness not get reduced by medicine, how can she feel well and think positively. We are feeling helpless, please suggest. Thank you.
Answered by Dr. Jonas Sundarakumar 2 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly advise and guide you regarding your would-be wife's problem. In order to understand her problem better, please provide the following clarifications...

How did this problem start (suddenly or gradually)?

Was there any particular stressful event or situation that triggered this problem initially?

Does she have an aversion to food or just vomiting, nausea and stomach discomfort?

How long after food does she vomit? Does she self-induce vomiting anytime?

How much of dysfunction is this problem causing to her and in what way?

Does she have any other symptoms like feeling low, decreased energy, lack of interest, negative thoughts, poor sleep?

Has she had any suicidal ideas or attempts before?

Does she suffer from any other medical problems or has she been under regular medication for any other problems?

Have you consulted a psychiatrist so far? Since when is she on Oliza and on what dosage?

Please get back to me with these clarifications, so that I can advise you in a better way.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Jonas Sundarakumar 50 minutes later
This problem started gradually from mid of 2011. We had to hospitalize her for the same issue thrice in 3 months from XXXXXXX 2011 to August 2011. Then till Dec 2011 she was well and good. But in 2012 her problem increased a lot, and this problem occurred once in every month. This year till today we have to hospitalize her almost 10-12 times.

yes there were some relationship problem with me and other friends arose in her life in that time. She was in severe stress and depression that time after her Higher Secondary exam in 2011. Then in December just before admitting to hospital she had a very stressful event in her family.

No she eats whatever she likes. She is very food loving girl too. But whenever her problem stats she rejects to have food, in fact she told us that she feels discomfort after having water.

She vomits immediately after eating. I mean her uneasiness starts after eating and some times she vomits immediately and sometime not. Yes she self induce herself sometimes in vomiting.
This thing is causing a hell lot of a problem to her. She is very good student but due to this problems she is being unable to give the exams. Her social life is getting hampered. She considers herself unlucky for that. Previously this problem is happening before exam so doctors told us that due to exam pressure this is having. But last 2-3 time exams were not there but still same problem is happening. She took a lot of pressure for exams and her studies.

All the problems you have mentioned are the correct symptoms for her. Even some thoughts like her dad's financial condition, parents condition these things comes her mind in this time in a bigger way.

She never attempted suicide before but she asks her father not to waste money for her as she does not want to live. She tells that she has lost all faith in living a good life etc etc. Also she is a very sensitive girl and if anybody tells her about anything she takes it seriously.

No this is the only problem that she is suffering for long.

Yes we have consulted a psychiatrist and she was under a doctor for past 6-7 months. But that doctor failed to show us any improvement. That doctor herself got confused. Now we consulted one doctor recently and he told that all these is psychiatric problem. She is having oliza for 5-6 months. Whenever that problem got severe doctor prescribe her Oliza 5.0 and later reduce the dose to 2.5

For past 15 days she is not being able to eat properly and her weight decreased a lot. First she was 47 kg and now 38. Please help her sir. Thank you.
Answered by Dr. Jonas Sundarakumar 14 hours later
Hello again and thanks for your clarifications.

I have gone through your description of her problem in detail and my opinion is that she is indeed having a psychological basis for her vomiting, more specifically a psychiatric condition called "conversion disorder". You have already mentioned that a complete medical evaluation, including a gastro evaluation and endoscopy has turned out negative. Moreover, considering her age, she is unlikely to have any major medical risk factors also. You have also mentioned that these symptoms become more prominent following stressful situations. So, it is very likely that her underlying anxiety and depression is manifesting itself through these bodily symptoms of vomiting, nausea, etc. This condition where her psychological stress and depression get converted to physical symptoms is what is called a "conversion disorder"

Now, this does NOT mean that she is simply imagining the symptoms or faking her illness. Not at all. Whenever a person has too much of mental stress and conflicts, and is unable to handle them, these psychological difficulties can get "expressed" or "manifested" as bodily symptoms. It has also been found that psychological disorders, like depression and anxiety are associated with certain neuro-chemical imbalance in the brain and this can cause the person to become more "sensitive" to bodily sensations like pain discomfort, etc.

Now, coming to the treatment part, Oliza (Olanzapine) is an anti-psychotic medication and is used to treat psychotic disorders (like Schizophrenia). My opinion is that your would-be seems to be suffering from underlying depression and anxiety problems, and so, anti-depressant medication would be more appropriate for her. Secondly, in these caes, where the person is having difficulty managing her stress, medication alone is not the only solution. What she needs is a detailed psychological assessment to find out what is causing her so much of psychological distress and counselling is essential. Counselling should be aimed at giving her emotional support, to help her come out with her stress and difficulties, and also, teach her coping skills and stress management techniques to handle her stress in a better way. There are certain specific psychotherapies like Cognitive Behaviour Therapy (CBT) which can help in changing her negative pattern of thinking and help her develop a positive attitude and more adaptive behaviour.

The recent worsening of her symptoms along with a weight loss of nearly 10 kg is very worrying. I would strongly advise that she needs to be seen in a good psychiatric centre - which has facilities for a detailed psychological assessment, admission, counselling, behaviour therapies, etc. (medical college hospitals or specialized psychiatric centres will have these combined facilities). I would once again like to let you know that simply giving psychiatric medication is not going to be giving her any long-lasting results. A proper psychological assessment, counselling and psychotherapy are important.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Jonas Sundarakumar 47 minutes later
But sir our main problem is her uneasiness and vomiting after eating is not stopping. how to stop that on immediate basis. Until this thing does not stop, she wont be able to control herself.
Answered by Dr. Jonas Sundarakumar 9 hours later
Hello again XXXXXXX

You must clearly understand that the primary reason why she is having the uneasiness and vomiting itself is because of her psychological problems. So, unless and until that is tackled and treated, her symptoms of uneasiness and vomiting is not going to stop. If there was a medical cause for her symptoms, then that can be treated immediately with medication, but in her case, there is no medical problem causing her symptoms. See, in the last 1 1/2 years, you she would have seen many doctors, had many medical evaluations and medical treatments. But why are her symptoms still persisting? It is because there is actually no medical problem which requires medical treatment. On the other hand, the cause is psychological. So, that is why I am insisting that her psychological problems must be treated first. Then, the nausea, vomiting and uneasiness will automatically stop. The previous hospitalizations, saline and other supportive treatments are just non-specific temporary measures which serve the purpose of giving her more attention and temorarily calming her down. But her problem has only kept reccuring after some time, because these brief hospitalizations cannot cure her primary problem, which is psychological.

I know that it may seem difficult to accept the fact that she has such obvious nausea, vomiting and stomach discomfort, but the cause is purely psychological! But, please understand that, as psychiatrists, we are well experienced with these kind of cases and it is very possible that underlying psychological problems can manifest as such symptoms.

For a quicker action, I would advise that she can be started on antidepressant medication immediately. There are certain anti-depressant medication like Mirtazapine, which not only have effects on controlling the underlying psychiatric problem, but also has a role in decreasing the physical symptoms of nausea and vomiting. Please discuss about these treatment options with her doctor. Since you mention that her condition this time is poor and that she has not eaten properly for 15 days and lost weight, she may require admission and supportive nutrition. But, please remember that in order to get cured of these symptoms completely, proper psychiatric treatment is essential.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Jonas Sundarakumar 13 hours later
Sir whenever she is eating fruits or ice cream she is not feeling that uneasiness. But after having rice or noodles(Maggi) she is feeling that uneasiness and trying to vomit. Also she is saying that she has a feeling like the food is sticking near her chest and causing problem.

We have talked to a psychiatrist doctor yesterday here but he prescribed medicines only.
Answered by Dr. Jonas Sundarakumar 10 hours later
Hi again and thanks for writing in.

Her problem of having symptoms of nausea and vomiting only for specific foods is inconsistent with any medical diagnosis. I am able to understand very well that you are genuinely concerned and worried about her health condition. It is indeed very difficult to witness a dear one suffering like this. But, please understand that though her symptoms may appear to indicate a medical problem, yet the cause is purely psychological. And so, only if this is treated correctly, her symptoms will get cured.

Unfortunately, many private practitioners do not dedicate time for counselling or psychological therapies and just prescribe medication. Though this can be partly helpful, yet in her case, she definitely needs counselling. That is why I had suggested that you take her to a higher centre where all these facilities will be available.

I hope and wish that your would-be is able to get the appropriate treatment and recover from her problem soon.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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