Terminology for TMS

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In his first books, Dr. Sarno gave the name "Tension Myositis Syndrome" (abbreviated TMS) to the condition that we refer to as TMS. The Latin root "myo-" refers to muscle and the latin root "-itis" refers to inflammation, so the phrase "tension myositis syndrome" roughly means "a collection of symptoms arising from tension and associated with inflammation in the muscles."

A problem with the term "tension myositis syndrome" is that the prefix "myo-" suggests that muscle is the tissue that is primarily targeted in TMS. However, we now know that tendon and nerve tissue can also be targeted in TMS. Similarly, the suffix "-itis" suggests that inflammation is an important part of Tension Myositis Syndrome. However, TMS does not generally involve inflammation. As a result of these concerns and perhaps others, Dr. Sarno's preferred term for the condition has changed over the years. Other parties have also put forth alternative names for the condition.

This document gathers written sources of information about various terms that have been put forth for TMS. Its approach could be described as, "just the facts," modeled after Wikipedia's policies of "Verifiability," "No Original Research," "Citing Sources," and "Neutral Point of View".

The natural place to start for Dr. Sarno's position is with his most recent book, The Divided Mind. Later, we will consider other reports about his positions as well as other terms put forth by other parties.

Dr. Sarno's Terminology in The Divided Mind

In The Divided Mind, Dr. Sarno defined the following four categories of disorders:
A.) Psychogenic disorders
B.) Psychosomatic / mindbody disorders
C.) Psychosomatic disorders that are directly induced by unconscious emotions (TMS and its equivalents)
D.) TMS
Each category is a subcategory of the type above it. For example, there are five categories of psychogenic disorders, one of which is is the category of psychosomatic disorders. Likewise, not all psychosomatic disorders are directly induced by unconscious emotions, and not all such psychosomatic disorders are TMS. The Divided Mind itself is primarily about the category of Psychosomatic disorders.

The following diagram summarizes how these four categories relate to one another. Each category contains all of the categories to the right of it. The capital letters in 12 point stars correspond to the four categories mentioned above

To explain the diagram, we offer short quotes that correspond to the capital letters in the 12 point stars.

A "Psychosomatic disorders belong to a larger group of entities known as psychogenic disorders, which can be defined as any physical disorders induced or modified by the brain for psychological reasons." (p.9) He then enumerates six classes of psychosomatic disorders:

1. harmless phenomena like blushing
2. cases in which the pain of a physical disorder is intensified by stress
3. reduction in physical symptoms from an existing disorder
4. hysterical disorders, which don't have a physiologic component and therefore are literally "all in your head" (these are primarily of historical interest)
5. psychosomatic disorders, which do have a physiologic component

B "Psychosomatic medicine specifically refers to physical disorders of the mindbody, disorders that may appear to be purely physical, but which have their origin in unconscious emotions, a very different and extremely important medical matter. Note that we will use the terms psychosomatic and mindbody interchangeably throughout the book, so don’t let it throw you." (p.2)

C "Psychosomatic disorders fall into two categories:

1. Those disorders that are directly induced by unconscious emotions, such as the pain problems (TMS) and common gastrointestinal conditions including reflux, ulcers, irritable bowel syndrome, skin disorders, allergies, and many others.
2. Those diseases in which unconscious emotions may play a role in causation, but are not the only factor. They include autoimmune disorders like rheumatoid arthritis, certain cardiovascular conditions, and cancer." (p.3)

D The remainder of the chapter is about psychosomatic disorders. He writes, "By contrast, in the fifth psychogenic group, psychosomatic disorders, the brain induces actual physical changes in the body. An example of this would be tension myositis syndrome (TMS), a painful disorder that we will examine at greater length. In this condition, the brain orders a reduction of blood flow to a specific part of the body, resulting in mild oxygen deprivation, which causes pain and other symptoms, depending on what tissues have been oxygen deprived." (p. 11)

"The most common disorders produced through [the neuro-peptide system] are those of TMS, described above. These disorders afflict millions and cost the economy billions of dollars every year in medical expenses, lost work time, compensation payments, and the like. Other conditions include:

• Gastroesophageal reflux
• Peptic ulcer (often aggravated by anti-inflammatory drugs)
• Esophagospasm
• Hiatus hernia
• Irritable bowel syndrome
• Spastic colitis
• Tension headache
• Migraine headache
• Frequent urination (when not related to medical conditions such as diabetes)
• Most cases of prostatitis and sexual dysfunction
• Tinnitus (ringing in the ears) or dizziness not related to neurological disease

The theories advanced here are based almost exclusively on work done with TMS, but there are many less common mindbody disorders (like reflux) whose symptoms are also created by the autonomic-peptide system. We refer to these as equivalents of TMS since they are the result of the same psychological conditions that are responsible for TMS. What put me onto the possibility that the pain I was seeing in the early 1970s was psychosomatic was the fact that so many of the pain patients had experienced these equivalent disorders, all of which I knew to be psychosomatic. That realization suggested that the pain disorder I was seeing was also psychosomatic." (pp. 14-15)

"Statistically, the most common psychosomatic disorder today is TMS, which I have described in its many forms in my previous books. I gave it that name because at the time of publication of the first book in 1984, it was thought that muscle (myo) was the only tissue involved. Since then, I have come to learn that nerve and tendon tissue may also be targeted by the brain; in fact, it now appears that nerve involvement is more common than muscle. Accordingly, a more inclusive name, like musculoskeletal mindbody syndrome, might be more appropriate. However, because the term TMS is now so well known, I have been urged by my colleagues not to change it, so TMS it remains." (pp. 13-14)

Other sources

See the following table for additional reports of Dr. Sarno's position on various terms for TMS, including "The Mindbody Syndrome" and "Psychophysiologic Disorders."

Date	Citation
2003	On pages 4 and 5 of To Be or Not to Be...Pain-Free: The Mindbody Syndrome (copyright 2003), Dr. Marc Sopher wrote, "Much of the chronic and recurrent pain and discomfort that we all experience is psychologically induced. This is the premise of Dr. John Sarno, who coined the term "tension myositis syndrome," or TMS, to better describe and treat this pain. He gave it this name because, in the early days of his work, it was his impression that muscle (myo) was the only tissue involved. Having realized in recent years that nerves, tendons and other body systems could be targeted by the brain in the disorder that he has described, we have decided that another term would be a more accurate designation for the entire process. After much thought and discussion, he and I have agreed that the term, The Mindbody Syndrome, would be a better choice and would be used henceforth in place of tension myositis syndrome. This has the virtue of retaining the acronym TMS, which has become familiar to many that have read Dr. Sarno's work. ...Using today's popular lingo, TMS is a mindbody disorder--the symptoms arise from the mind and are experienced by the body. Thus, The Mindbody Syndrome is an appropriate title." Text very similar to the above can be found on Dr. Sopher's website, at http://www.tms-mindbodymedicine.com/tmsinfo.htm.
2006	In his most recent book The Divided Mind, Dr. Sarno Tension Myositis Syndrome to refer to TMS. He also suggested that "a more inclusive name, like "musculoskeletal mindbody syndrome, might be more appropriate." (p. 14)
2007	In an interview on April 10, 2007, Dr. Sarno stated that "Even in the The Divided Mind...I called it 'myositis'...Very recently I decided we should call it the myoneural, Tension Myoneural Syndrome..." source.
2008	In an interview posted on the WBAL TV website as part of their 5/1/08 report on TMS, Dr. Sarno says, at time 4:50, "By the way, was I specific? I now call it 'Tension Myoneural Syndrome,' and anything that I'm writing now and of course for what we are doing now I want it to be known that it is 'myoneural.'"
2009	In an online discussion, Dr. Barta wrote (4/8/09): ' Psychophysiological Disorder [as above]( with specifications for Muscluloskeletal psychophysiological disorder, Gastrointestinal psychophysiological disorder, Genitourinary psychophysiological disorder) ' + Will be consistent with new terms Dr. Sarno will be writing about in his new book (he mentioned this today on 4/8/09 - Barta). + Dr. Sarno mentioned that TMS (tension myositis syndrome) is obsolete now and this is a better description
2013	In his forward to Pathways to Pain Relief, Dr. Sarno wrote, "My books have described this process in detail. I call the disorder the Tension Myoneural Syndrome (TMS)." (p. xxiii)

Alternative Names for TMS

Automatic Overload Syndrome (AOS): Dr. Scott Brady developed the term AOS to describe chronic conditions, which he discusses in his book Pain Free for Life. Brady defines AOS as a group of chronic pains and other symptoms caused by harmful levels of stress, pressure, and repressed strong negative emotions that have built up in the subconscious mind. The symptoms of AOS include back pain, headaches, irritable bowel syndrome, insomnia, and other chronic conditions. Brady focuses on stress and pressure that builds up in the autonomic nervous system, which causes these conditions. [Brady, Scott. Pain Free for Life. New York: Hachette Book Group. 2006. pg. 8]

Mind Body Syndrome (MBS): Dr. Howard Schubiner calls the condition of having chronic symptoms caused by psychological factors as MBS. Schubiner says "MBS is caused by a complex set of neurological connections between the brain and the body, rather than a disease localized in one area of the body." MBS symptoms include chronic pain syndromes, such as tension headaches, back pain, fibromyalgia, and Myofascial Pain syndrome, as well as autonomic nervous system related disorders such as irritable bowel syndrome and Reflex sympathetic dstrophy. Other symptoms are also included in MBS like insomnia, Tinnitus, Anxiety, and Chronic fatigue syndrome. [Schubiner, Howard. Unlearn Your Pain. Pleasant Ridge: Mind Body Publishing. 2010. pg. 8-19]

Stress Illness: Dr. Dave Clarke has coined the phrase Stress Illness to diagnose conditions that are chronic and caused by psychological factors of stress and the repression of emotions. Clarke argues that there are five different kinds of stress that create physical symptoms such as childhood, current, traumatic, depression and anxiety disorders. Clarke argues that other names such as psychosomatic and somatoform disorder suggest that the patient's symptoms are either not real or are part of a psychological disorder instead of being cause by stress. Clarke writes "Sufferers are often unaware of the nature or degree of the stress that makes them ill. Symptoms can occur anywhere in the body and can be just as severe as symptoms caused by any other disease, but x-rays and blood tests cannot detect the cause." [Clarke, Dave. They Can%27t Find Anything Wrong. Boulder: First Sentient Publications. 2007.]

Psychophysiologic Disorder (PPD): The Psychophysiologic Disorders Association, which has had several of Dr. Sarno's most trusted colleagues on its board, suggests the term Psychophysiologic disorders to refer to TMS. Some information about their process for choosing this term can be found in Why PPD.

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