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Ask the Mental Health Expert Archives 2001-2004

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Finger and Toe Pain

Q. I experienced extreme discomfort in my fingers and toes. To relieve the stress in my feet, I wear about four pair of socks and tight shoes helps. I get temporary relief in my hands when my husband squeezes my fingers together as hard as he can. I've taken Paxil for a year now. It's helped and now I can be touched.

Before Paxil even being in close proximity of my husband would cause extreme tension. I'm hoping there can be more relief. When I don't have shoes on first thing in the morning, I turn into Mr. Hyde. I recently read a brief description of Tactile Defensiveness and the description fit me perfectly. This includes the part about not having spatial adeptness and appearing clumsy. Is there anything that can provide me with more relief?

A. This sounds like a frustrating and puzzling condition. It's hard to know what to advise you without a clearer sense of what, precisely, your condition is. Therefore, if you haven't yet seen a medical specialist, I would recommend that you do so.

What you call tactile defensiveness is usually described in children with neurodevelopmental problems, such as autism. It would be unusual to see the onset of this condition in adulthood, but you don't say how long you have experienced it. I also wonder if you may have more than one process going on.

The extreme discomfort you describe in your fingers and toes might be a neurological or a vascular disorder; for example, a condition called Raynaud's Syndrome has some things in common with what you describe. Although this is usually brought on by the cold, sometimes it can be set off by emotional factors. Many separate causes may underlie this syndrome, and it is important to pin down the actual cause. Fortunately, there are medical treatments for Raynaud's Syndrome. Seeing a neurologist or a vascular specialist would be a good place to start.

On the other hand, the extreme tension that you describe, even in close proximity to your husband, might suggest some kind of anxiety or phobic condition. Interestingly, tactile defensiveness has been linked with phobic anxiety in children, and may lend itself to behavioral forms of treatment (see Arnold & Sheridan, J Sch Health 1980;50:531-33). That Paxil seems to have helped you is interesting, since this is a medication used in the treatment of both anxiety and depression. Perhaps an increase in dose, if medically appropriate, would be helpful for you.

If your neurological and medical work-up is completely normal, consulting with a psychiatrist and/or a behavioral psychologist might be worth considering. I hope you get to the root of this perplexing problem, and find some relief soon!

June 2002

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