I already sent you a msg but just read through this as well. The cause is not emotional unfortunately. The severity of VTOS increases with activities where arms are raised above head. More common in athletes due to repetition of motion- tennis, water polo, etc. Washing my hair still causes pain and flares. The big problem is most tests will not show any compression! They have you laying with arms in a position that minimizes this effect. If they could take a test while you are over-extending it would show something different. Between my two surgeries I was on coumadin (blood thinner) for 3 months. There was a bad incident where I ended up at the ER- I could feel the vein pinched on the right side. The tests did not show this and I had no clots so I was sent home. Turns out my INR was almost a 6. (therapeutic blood level should be btwn 2-3). So if my blood had not been so thin I probably would have clotted on that side as well. Two weeks later I had that rib resection. Just remember to listen to your body. Doctors can only provide their best medical opinion. They cannot tell what you are really going through- especially since so little is really understood about TOS. Every time you lift your arms there could be compression on the vein...it may never clot, though.