DPDR, Chronic Pain, Chronic Fatigue, Health Anxiety, OCD & Anxiety...
Why are these conditions so often linked?
I'm not saying everyone I see has all of these conditions at once. However, I rarely see a client with only DPDR. In fact, around 99% of my clients have at least one co-occurring condition.
Some of the most common conditions I see alongside DPDR include:
Chronic fatigue
Insomnia
Migraines and headaches
Endometriosis or pelvic pain
Random tingling or numbness without an obvious cause
Back pain
Bladder pain, frequent urination or recurring UTIs
Tinnitus
Fibromyalgia
Tight muscles and unexplained soreness
Visual snow or other vision disturbances
Health anxiety
OCD
Depression
Agoraphobia
Various phobias
...just to name a few.
If this relates to you I know it takes a lot to even consider the idea that some of your symptoms could be influenced by your nervous system - especially if you've been given a physical diagnosis. I'm not asking you to dismiss your diagnosis or ignore your body. I'm simply asking you to read on by staying curious rather than immediately closing the door on an idea that may be new, and perhaps even confronting....
I mention this YouTube talk by Dr. Howard Schubiner at the end of the blog, but you may like to watch it before reading on. It provides a great foundation for the concepts I'll discuss and may make the blog easier to digest: https://www.youtube.com/watch?v=1zkmLBXoc-E&t=2175s
The brain's job is to protect you...
When clients experience these symptoms, their minds and bodies often interpret them as signs of danger. And whilst some pain absolutely can originate from physical conditions (for example, endometriosis can certainly cause pain), our nervous system can also learn to generate or amplify symptoms as a protective response.
Think about it this way.
If you've experienced years of endometriosis pain, your brain has built a very strong neural pathway around that pain. Once that pathway exists, it's much easier for an already overprotective nervous system to send danger signals down the same pathway - even if there isn't new tissue damage occurring.
Your brain isn't trying to hurt you.
It's trying to protect you.
I know you're probably thinking...
"How on earth is giving me MORE pain protecting me?"
Because biology has one primary goal: keeping you alive.
If your brain believes you're under threat - whether that's from chronic stress, anxiety, trauma, burnout or prolonged illness - it may try to slow you down. Rest. Withdraw. Conserve energy. Become hypervigilant.
For one person, that protective response might look like fatigue.
For another, tinnitus.
For someone else, tingling, numbness, headaches or pain.
And for many of us...
...it looks like DPDR.
DPDR isn't the only protective response
One of the biggest things that helped me recover was understanding that DPDR isn't some bizarre, isolated condition.
It's another protective response of the nervous system.
Pain, fatigue, ringing in the ears, dizziness, tingling and DPDR all have something important in common...
They are real symptoms, generated by the brain and nervous system.
That doesn't mean they're "made up."
It doesn't mean you're imagining them.
It doesn't mean your suffering isn't real.
It means the brain is responsible for creating all conscious experiences of pain and many protective symptoms. For example, when you break your arm, the broken bone doesn't "produce" pain on its own. Your brain receives information from the injury and generates pain to protect the area.
Likewise, when you have the flu, the virus causes infection—but your overwhelming fatigue is something your brain creates to encourage you to rest and recover.
The nervous system is incredibly intelligent.
Sometimes...
It's simply too protective.
Why this often gets missed
Unfortunately, many GPs receive very little formal training in modern pain neuroscience or neuroplastic pain.
Naturally, they look for structural explanations for symptoms - and often they find something.
A disc bulge.
A cyst.
Tight muscles.
Mild degeneration.
Endometriosis.
And whilst these findings may explain symptoms, they don't always.
Research consistently shows that many people who have absolutely no pain also have disc bulges, arthritis, labral tears, cysts and other structural findings.
That's why one of the most important questions isn't simply:
"Is something showing up on my scan?"
It's:
"Does this finding actually explain my symptoms?"
Once we're given a diagnosis, our brains naturally become attached to it.
"My neck is tight... that's why I'm getting migraines."
"My scan showed degeneration... that's why my back hurts."
We begin anticipating pain.
Watching for it.
Preparing for it.
The nervous system interprets this constant vigilance as evidence that danger is still present.
Which creates more fear.
More tension.
More symptoms.
And the cycle continues.
DPDR works in exactly the same way
The more you monitor DPDR...
The more present it feels.
The more you analyse it...
The more convinced you become that you're trapped.
Many people receive a diagnosis and unintentionally begin believing they'll never recover.
Their attention narrows onto DPDR.
The nervous system stays in fight, flight or freeze.
The brain continues predicting danger.
The symptoms remain.
I know this cycle intimately because I lived it myself.
And I also know it can be broken.
Recovery is possible.
(You can find my book on recovering from DPDR here: https://buymeacoffee.com/therapy_em/e/546246)
This is where Dr. Howard Schubiner's work changed everything for me...
Dr. Howard Schubiner is a triple board-certified physician in the United States who specialises in neuroplastic pain, chronic fatigue, anxiety and other nervous system conditions.
One thing I love about his work is that he doesn't tell people to ignore their symptoms or assume everything is psychological.
Instead, he recommends a balanced approach as follows:
Step 1: Get an appropriate medical assessment.
Rule out conditions that genuinely require medical treatment, such as fractures, infections, inflammatory diseases, neurological disorders or other significant illnesses.
The goal isn't endless testing.
It's making sure nothing important has been missed.
Step 2: Understand that scans don't always equal pain.
Many people without pain have:
Disc bulges
Herniated discs
Arthritis
Labral tears
Rotator cuff tears
Meniscal tears
His question is always:
"Does this finding actually explain the person's symptoms?"
—not simply—
"Is there something on the MRI?"
Step 3: Look for positive signs of neuroplastic pain (IMPORTANT).
Rather than diagnosing neuroplastic pain simply because tests are normal, he looks for clues such as:
Pain that moves around the body.
Symptoms that fluctuate dramatically.
Pain that increases during stress.
Symptoms beginning during a stressful period of life.
Pain lasting long after tissues should have healed.
Good days and bad days without a clear physical explanation.
Getting treatment that "helps" initially but wears off quickly.
Numerous treatments failing despite no worsening of tissue damage.
These patterns suggest the nervous system has become overprotective.
Step 4: Remember that tissues heal.
Most tissues heal within weeks to months.
If someone continues experiencing severe pain years later without evidence of ongoing tissue damage, it's reasonable to consider whether the nervous system has become sensitised.
That doesn't mean every chronic symptom is neuroplastic.
It means it's worth considering the whole picture.
Step 5: Pain is real - but it isn't always signalling danger.
One of Dr. Schubiner's favourite analogies is a smoke alarm.
A smoke alarm should go off when there's a fire.
But sometimes...
It goes off when you're making toast.
The alarm is real.
The noise is real.
But the danger isn't.
Our nervous systems can behave the same way.
The pain is absolutely real.
The nervous system is simply overestimating danger.
Step 6: Diagnose by positive evidence - not just by exclusion.
One thing I appreciate about Dr. Schubiner is that he doesn't say,
"We couldn't find anything, so it must be psychological."
Instead he asks:
Has appropriate medical assessment ruled out conditions requiring treatment?
Does the symptom pattern fit neuroplastic pain?
Does the person's history support an overprotective nervous system?
That's a very different conversation.
Could this be the missing piece?
I'd love for you to explore more of Dr. Schubiner's work:
https://www.youtube.com/watch?v=1zkmLBXoc-E&t=2175s
Are you open to this idea?
I know it's incredibly difficult to hear when you've lived with pain or physical symptoms for years.
But how do we truly know whether our symptoms are being maintained by an overprotective nervous system unless we're willing to remain curious and try evidence-based interventions?
If you've experienced childhood trauma, PTSD, bullying, chronic stress, burnout or prolonged anxiety, there's a good chance that modern pain science could become an incredibly valuable part of your healing journey.
As you're listening to Dr. Schubiner, try mentally swapping the word "pain" with "DPDR."
You might be surprised by just how much of it applies.
With love,
Em
P.s. Please note: This article is not suggesting that all chronic pain or physical symptoms are neuroplastic. Many medical conditions require appropriate diagnosis and treatment. The purpose of this article is to introduce the idea that, for some people, an overprotective nervous system may contribute to or maintain symptoms even after appropriate medical assessment.
