Are Tension Myositis Syndrome (TMS) and Psychophysiological Disorder (PPD) the same thing?
We get the above question from time to time and so I thought I'd aim to get things straight on PPD and TMS.
You might have come across both the terms Tension Myositis Syndrome (TMS) and Psychophysiological Disorder (PPD) and either feel confused by the differences or assumed they were the same thing. I mean, they both deal with the connection between the mind and body, right? But if we look into it more, we start to realise there are some key differences—and similarities—that are worth understanding. So, if you’ve ever wondered whether TMS and PPD are the same thing, or how they’re related, stick around because I’m about to break it down.
What is Tension Myositis Syndrome (TMS)?
Let’s start with Tension Myositis Syndrome, also known as TMS. The term was coined by Dr. John Sarno, a physician who became famous for his belief that a lot of chronic pain isn’t due to structural issues, like herniated discs or bad posture, but rather emotional and psychological stress. According to Sarno, when we repress emotions like anger, fear, or anxiety, our brain essentially "distracts" us by creating physical pain. It's like your mind’s way of keeping you from dealing with emotions you’d rather avoid.
The idea is that the pain is real—totally physical—but the cause is psychological. And it’s not just back pain that Sarno talked about. He believed that TMS could be responsible for a wide range of issues like neck pain, fibromyalgia, and even conditions like irritable bowel syndrome (IBS). Irritable bowl syndrome, however, would be considered a TMS equivalent and not TMS itself. The core idea behind TMS is that unresolved emotional issues are causing tension, due to mild oxygen deprivation to the tissues of your body, leading to pain, but it can be fixed by addressing the emotional root of the problem.
What is Psychophysiological Disorder (PPD)?
Now, Psychophysiological Disorder (PPD) is a broader term that refers to any condition where psychological factors play a significant role in creating physical symptoms. These symptoms could be anything from chronic pain to digestive problems or even skin conditions like eczema.
The term PPD doesn’t just apply to pain, though. It encompasses a whole range of physical symptoms that have a psychological origin. Think of conditions like tension headaches, stress-induced ulcers, or even high blood pressure that's triggered by anxiety. The common thread in PPD is that the symptoms have no clear structural cause—like a broken bone or an infection—but they are very real and can be incredibly debilitating.
The Overlap: How are TMS and PPD Similar?
So, now that we’ve got the definitions of TMS and PPD, it’s easy to see where the confusion comes from. Both concepts revolve around the idea that emotional or psychological factors can cause real physical symptoms.
1. Feelings, Emotions and Stress: Both TMS and PPD acknowledge that the mind and body are closely connected. In both cases, unresolved emotional issues like stress, anxiety, or trauma can lead to physical symptoms.
2. Non-Structural Causes: Both TMS and PPD emphasize that the pain or symptoms you’re experiencing aren’t due to structural problems, like an injury or disease. Instead, they’re often rooted in your mental state.
3. Treatment: Because both TMS and PPD stem from psychological factors, the treatment approaches can be similar. They mostly focus on addressing the emotional root causes of the symptoms, through things like therapy, coaching, expressive writing, mindfulness practices, better self awareness and so fourth. Dr. Sarno, for instance, believed that once people fully accepted that their pain was psychological and not physical, the pain would start to go away (this is the the case for some but not all cases). In treating PPD, many practitioners also focus on emotional awareness, reducing stress, and changing thought patterns that contribute to symptoms.
Key Differences: TMS vs. PPD
Even though TMS and PPD are similar in many ways, there are a few distinctions to be aware of.
1. Scope: TMS, as Sarno defined it, is primarily focused on musculoskeletal pain—think back pain, neck pain, or shoulder pain that involve soft tissues and nerves. PPD, on the other hand, is a much broader term that includes any physical symptom caused by psychological factors. So, while all TMS cases could technically fall under the umbrella of PPD, not all PPD cases would be considered TMS. For example, an stress-induced skin rash would be considered PPD, but not TMS, since it doesn’t involve muscle or joint pain.
2. Origin: TMS specifically hinges on the idea that repressed emotions—like anger or fear—are the driving force behind the physical symptoms. It’s very focused on the emotional repression angle. PPD, while acknowledging that psychological factors are involved, doesn’t necessarily stick to the idea of repression being the main cause. PPD could involve anxiety, stress, or trauma in a more general sense.
3. Theoretical Approach: TMS is tightly linked to Sarno’s theories and beliefs, which makes it a bit more rigid in its explanations. PPD, however, is more of a modern umbrella term that includes a variety of mind-body disorders. You could say that TMS is a specific type of PPD, but PPD can also refer to conditions that don’t fit neatly into the TMS framework.
Which Term Should You Use?
Many of you who have found this blog might have done so because you know about TMS and Sarno's work and you might feel confident that what you are experiencing is TMS. Or you are working through our recovery program and you’re still trying to figure out what’s going on with your body—whether it's chronic pain, digestive issues, or some other mysterious physical symptom—both TMS and PPD can offer a helpful way of thinking about your condition since TMS is a symptom that comes under the PPD umbrella. But is one term better or more useful than the other?
Honestly, it depends on who you’re talking to. If you’re with Dr. Sarno and feel confident that emotional repression is at the root of your pain, then TMS might be the term that resonates with you. On the other hand, if your symptoms go beyond pain, or if you’re not totally on board with the repression, PPD might feel like a better fit.
It has to be said that TMS is a bit more of a niche term, mostly used by people who are familiar with Sarno’s work. While PPD, on the other hand, is becoming more widely accepted in the medical and psychological communities. If you’re seeing a doctor or therapist, they’re probably more likely to use the term PPD.
My Conclusion: Are They the Same?
As I mentioned earlier, you can think of TMS as a specific type of PPD—one that focuses on musculoskeletal pain caused by repressed emotions. PPD, on the other hand, is a broader term that encompasses all sorts of physical symptoms caused by psychological factors, not just pain.
At the end of the day, whether you are dealing with TMS or another symptom of PPD, the takeaway is the same: our minds and bodies are deeply connected, and very often the root cause of physical symptoms isn’t a physical problem, but an emotional or psychological one, and because of this the approach to healing is often exactly the same.
All the best for now and, if you enjoyed this post, please share your thoughts and feelings, it’s always a pleasure to get feedback!
Duncan