Shneidman coined the term ‘PSYCHACHE‘ and he used the word to refer to unbearable mental pain, inner torment and turmoil. He theorized that this terrible mental pain was caused by:

  • unmet psychological needs (see ‘UNMET CORE NEEDS’ below).


  • a combination of various negative emotions (including guilt, fear, helplessness and loneliness) to form a GENERALIZED MENTAL ANGUISH

Other researchers have also tried to explain what is meant by the concept of this so-called ‘psychache.

For example, Bolger described it as a ‘brokenness of self’ and Herman states that it is based upon a negative sense of self and trauma.

Sandler hypothesized that psychological pain derives from a cognitive dissonance involving a vast disparity between one’s ACTUAL IMAGE of oneself and one’s IDEAL IMAGE of oneself.

Bakan believed that extreme mental suffering is brought about from a separation from a significant other that gives rise to a collapse in one’s sense of ‘wholeness’ and ‘social unity.’

Baumeister regarded psychological pain as stemming from a deep sense of personal inadequacy and a failure to live up to one’s ideal standards, achieve one’s goals or fulfil one’s hopes (all of these failures, the person in profound pain, attributes to his/her own personal failings).

As I have written in other articles on this site, those with borderline personality disorder (which is a very serious psychiatric condition strongly associated with childhood severe and protracted interpersonal childhood trauma) are especially prone to chronic phases of mental torment which can persist as a baseline mood. Living in such excruciating mental pain, constantly, day in and day out goes a long way to explaining why those with BPD are frequently so easily ‘tipped over the edge’, exploding into a rage, attempting suicide, binge eating, excessive drinking etc. Such individuals are at their absolute limit of endurance so even events that may appear trivial to others can easily provoke such out-of-control responses which are, of course, both self-destructive and destructive to others; such behaviours can be seen as knee-jerk responses to psychological pain and a desperate attempt to ameliorate it (in relation to this, you may wish to read my previously published article Dysfunctional Tension Reduction Activities Complex PTSD And BPD Sufferers May Use) but, because they are dysfunctional coping mechanisms, invariably plunge the BPD sufferer deeper still into his/her abyss of despair and desperation.




Like Shneidman, Timulak et al., 2012, believed core unmet needs underlie the type of emotional suffering referred to above. According to Timulak, these are:

  • unmet needs for safety and security
  • unmet needs for love and meaningful connection to others
  • unmet needs for acceptance, validation and recognition by others 

Sadly, such unmet needs frequently stem from growing up in a  dysfunctional family. (To read my previously published article: Dysfunctional Families: Types And Effects, click here).

Core Feelings Associated With Core Unmet Needs :

Timulak elaborates on the above by stating that these three core unmet needs are associated with corresponding core feelings as shown below :

  • unmet needs for safety and security are associated with feelings of fear and insecurity
  • unmet needs for love and meaningful connection to others are associated with feelings of sadness and loneliness
  • unmet needs for acceptance, validation and recognition by others are associated with feelings of shame and worthlessness

Secondary Distress And Obscured Core Unmet Needs And Feelings :

Timulak also alerts us to the fact that when individuals suffering from emotional pain present themselves to therapists, their core unmet needs and corresponding core feelings may be obscured and concealed because these are superimposed by surface, ‘secondary distress’ (i.e. distressing, surface feelings that have their roots in the underlying core unmet needs and associated core feelings).

Examples of such ‘secondary distress’ / ‘surface feelings’, Timulak states, include :

  • feelings of helplessness
  • feelings of hopelessness
  • feelings of depression
  • feelings of anger
  • feelings of anxiety
  • somatisation (e.g. insomnia, physical tension, exhaustion, teeth grinding, stomach pains, chest pains, loss of appetite, headaches, dizziness etc.)

It is important for patients and therapists to consider the possible core issues that may lie beneath adverse surface feelings (secondary distress). Often, these core issues will have their roots in childhood trauma.


Image information adapted from Timulak et al., 2012


Can Emotional Pain Be Treated Like Physical Pain?

It hardly needs stating that emotional pain can feel unbearable; after all, it drives some to suicide. As well as knowing this from a theoretical perspective, I know from personal experience; I spent five days in a coma in intensive care following a suicide attempt, as I have written about previously in other articles that I have published on this site.

[NB. If you are feeling suicidal, you are strongly advised to contact an appropriately qualified professional].

But what is actually going on in the brain, in physiological terms, to cause such excruciating suffering?

Findings Of Recent Study:

A recent study was conducted on volunteers who were shown a photograph of a partner who had recently rejected them. Whilst looking at the photographs, these volunteers (a little cruelly, it could feasibly be argued!) were told to concentrate upon how badly the rejection made them feel.

Brain scans revealed that whilst the volunteers were focusing on the pain of rejection whilst looking at the photographs, the brain regions that were activated were very similar to those known to be activated by physical pain, in particular:



This suggests that both physical and psychological pain have similar neurological underpinnings.

It seems reasonable to conclude, on the basis of the two studies described above, that not only do physical and psychological pain share common neurological foundations but that, because of this, some psychological pain (such as that connected with anxiety) may respond to treatments originally intended to combat physical pain. However, research into this area of study is at an early stage so definitive conclusions must be drawn with caution.




David Hosier BSc Hons; MSc; PGDE(FAHE).