11/14/24, 10\:55 AM Medically Unexplained Symptoms

Medically Unexplained Symptoms

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Medically unexplained symptoms (MUS)\: physical symptoms not secondary to an underlying physical condition, a
any bodily system.
Terminology\: ICD 11 and DSM 5 use “functional” for diagnostic purposes; also described as somatic symptoms.
Prevalence\: 25-50% of symptoms in primary care are medically unexplained; 2.5% of patients in general practice meet
criteria for persistent or severe MUS.
Aetiology\: Brain-body communication via the nervous system and hormones (mind-body link); physical changes from
thoughts, feelings, stresses (
Risk factors\: Stress from various life aspects, past or recent abuse, history of mental health conditions (e.g., depression,
anxiety).
Common symptoms\: Muscular/joint pain (especially back), headaches, fatigue, dizziness, chest pain, palpitations,
gastrointestinal symptoms (pain, bloating, change in bowels), neurological symptoms (seizures, weakness, paralysis,
numbness).
Investigations\: Necessary to exclude organic pathology, depending on presenting symptoms.
Diagnosis\: Positive diagnoses made through biopsychosocial assessments by psychologists, psychiatrists, physical health
doctors, and allied health professionals. Speci
somatoform disorder, dissociative/conversion disorder, hypochondriasis, body dysmorphic disorder.
Management\: Consistent management by a multidisciplinary team, patient education, cognitive behavioural therapy (CBT),
psychotherapy, mindfulness, physical exercise, antidepressants for co-morbid depression. Symptoms decrease in 50-75%
of patients over 6-15 months; reconsider organic pathology if symptoms change.
Complications\: Lack of training and guidelines, repeated/invasive investigations, inappropriate treatment, chronic
disability, risks to physical health, and use of healthcare resources.
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A comprehensive topic overview

Introduction

Medically unexplained symptoms (MUS) are physical symptoms in the body which are not secondary to an underlying
physical condition but can be understood by other factors. Symptoms can involve any bodily system.
1
ICD 11 (International Classi
term “functional” for diagnostic purposes. 2 3
They may also be described as somatic symptoms.
25-50% of symptoms presented in primary health care are medically unexplained and 2.5% of patients in general practice
meet the criteria for persistent or severe MUS.
1

Aetiology

Two-way communication occurs between the brain and body via the nervous system and hormones. This is sometimes
called the mind-body link.
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Thoughts, feelings, and stresses make physical changes in the body. This may be through the
where the brain recognises danger and releases adrenaline to prepare it for action. Physical changes can also occur
through the disruption of messages between the brain and body via the nervous system and hormones. In addition,
physical disease can also a
3
Symptoms also can be understood due to neural circuit abnormalities, which alter the constructs in the brain.
4

Risk factors

Stress is a signi
home, school, work, family, friends, and relationships. There is also often an association with past or recent abuse.
5
MUS are more likely if there is a history of mental health conditions such as depression or anxiety, particularly health
anxiety. Mental health conditions can also cause physical symptoms.
3

Clinical features

The most common symptoms reported include\:
3
Muscular or joint pain, particularly in the back
Headaches
Fatigue
Dizziness
Chest pain
Palpitations
Gastrointestinal symptoms\: pain, bloating, change in bowels
Neurological symptoms\: seizures, weakness, paralysis, numbness
A relevant clinical examination is required to exclude organic pathology. Symptoms are unlikely to improve following the
exclusion of physical disease.
3

Investigations

Relevant investigations are essential to exclude organic aetiology of presenting symptoms. These will depend on the
presenting clinical features.

Diagnosis

MUS and functional disorders are not diagnoses of exclusion but positive diagnoses.
They are diagnosed by conducting biopsychosocial assessments by psychologists and psychiatrists in conjunction with
physical health doctors and other allied health care professionals (e.g. physiotherapists and occupational therapists) to
understand the pathophysiology of the symptoms.
Diagnoses for speci
3
Irritable bowel syndrome (IBS)
Fibromyalgia
Non-epileptic attack disorder (NEAD)
Diagnoses due to the causes of these symptoms include\:
3
Somatoform/somatisation disorder\: symptom(s) thought not to be physical in origin
Dissociative/conversion disorder\: neurological symptoms
Hypochondriasis\: concerns about speci
Body dysmorphic disorder\: concerns about a feature of the body
Persistent delusional disorder should also be considered if the concern is a
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Management

The whole team must be aware of the diagnosis and management plan to ensure consistent management. Involvement of
a multidisciplinary team, including psychology & psychiatry, is often required.
5
Patient education around diagnosis and management of stress is important. Reassurance alone is often not e
helpful to encourage patients away from further research and investigation for their symptoms.
Talking therapies such as cognitive behavioural therapy (CBT), psychotherapy, and mindfulness may be used. Physical
exercise has been shown to be bene
5
Antidepressants may have some e
3
Symptoms will decrease in 50-75% of patients over 6-15 months. If symptoms change, clinicians should reconsider the
possibility of organic pathology.
5

Complications

There is currently a lack of training in medical school around MUS and limited guidelines for general practice, which can
lead to suboptimal management.
5
Complications may result from repeated and invasive investigations attempting to determine an organic cause of the
symptoms.
Additionally, some doctors may give inappropriate treatment for organic disease to patients presenting with MUS. This
includes risks to physical health and the use of healthcare time and resources. If not appropriately managed, MUS can
lead to chronic disability.
5

References

T Hartman, H Woutersen-Koch, H Van der Horst. B r i t i s h J o u r n a l o f G e n e r a l P r a c t i c e . Medically unexplained symptoms\:
evidence, guidelines, and beyond. 2013; 63(617) 625-626.
International Classi
J Bolton, D Attard. Royal College of Psychiatry. Medically unexplained symptoms. November 2015. Available from\: [LINK]
Drane DL, et al. (2000) A framework for understanding the pathophysiology of functional neurological disorder. C N S
S p e c t r u m s
C Tidy, H Willacy. Medically Unexplained Symptoms – Assessment and Management. 21 Apr 2023. Available from\: [LINK]

Reviewer

Dr Laavanya Damodaran
Consultant Paediatric Liaison Neuropsychiatrist
Birmingham Children’s Hospital

Related notes

Anxiety Disorders
Bipolar Disorder
Bulimia Nervosa
Depression
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Personality Disorder

Test yourself

Contents

Introduction
Aetiology
Risk factors
Clinical features
Investigations
Diagnosis
Management
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