Medically Unexplained Symptoms: key
A physical cause cannot always be found for
bodily symptoms. These are often called “medically unexplained
symptoms”. However, they can be explained by thinking
about causes that are not just physical.
What sorts of symptoms can be medically unexplained?
The commonest such symptoms include:
- pains in the back, muscles or
- feeling faint
- chest pain or heart
- stomach problems.
What causes medically unexplained
We can often explain such symptoms when we
look at how our thoughts, feelings and stresses can affect our
bodies. But – to say that symptoms are not just physical is
not the same as saying they are all in
the mind.To understand them, we have to think about how the mind
and the body work together.
How are the mind and body linked?
There is two way communication between our
brains and bodies. This communication is via the nervous system and
by hormones that circulate in the bloodstream.
Every day, thoughts, feelings and stresses
play a part in making changes in our bodies. For example when
we feel embarrassed, we blush. When we get upset we feel our
throat tighten – “a lump in the throat”.
We also know that the way we think and feel
can make us physically ill. Long-term stress can make us more
likely to have high blood pressure or a heart attack.
Ways of thinking about the mind and the
There are different ways of thinking about how
the mind and the body are linked that can help us to understand
medically unexplained symptoms.
- Like a Computer - hardware
You can think of your brain and nerves as
being like computer “hardware” and the electrical messages that run
through the nervous system like programmes or “software”. Symptoms,
such as weakness in a limb, or collapsing, can occur because of a
“software” problem, even though the “hardware” is intact.
These “software” problems can happen when you
are under a lot of stress. Stress seems to interfere with
messaging (or “software”) of the brain and nerves.
Another similar way of thinking about the
cause of symptoms is like a car or piano being out of tune.
All of the parts are there, but they aren’t working properly.
Physical symptoms due to stress
We have evolved a way of responding to stress
that gets our body ready for physical action. However, we
don't need to physically react to most of the stresses in our
lives. So our body’s stress response gets going - but there
is nowhere for the energy to go.
This stress response can give you physical
symptoms such as:
- rapid heartbeat and
- chest tightness and
- dizziness, faintness and
feeling light headed
- indigestion, feeling sick,
- tightness in the throat
- muscle tension and
A vicious circle can make symptoms worse
Physical symptoms of stress can worry us,
especially if we don’t know why they are happening. This worry
can cause even more stress and bodily symptoms, making us feel even
worse. This is more likely to happen if stress goes on for a
Similarly, pain can make us feel miserable and
depressed, especially when it goes on for a long time. In turn,
feeling depressed lowers our pain threshold and makes the pain feel
Being ill with anxiety or depression can cause bodily
Anxiety or depression affect our mood, but
they can also cause physical symptoms. We may recognise the
physical symptoms, but find it harder to see that we are anxious or
depressed. So we tend to think that these symptoms are due to a
physical cause – when there is none.
When we are ill with anxiety, the body’s
stress reaction is switched on when it is not needed. Some of
the bodily symptoms that come with anxiety are described in
Depression not only makes us feel low or sad,
but it also affects the body and causes symptoms such as loss of
appetite and weight, low energy, tiredness and general aches and
Can I have a physical illness and medically
It is common for people to have a physical
illness, but also to have physical symptoms that are not fully
explained by that illness. Often this is because a physical
illness can causes emotional stress – which then creates physical
symptoms of its own.
What tests should I have for my symptoms?
Your doctor can discuss with you what
investigations you need for the symptoms you have to look for
anything important. It is often unhelpful to have
investigations that are unlikely to show anything. They can make
someone worry even more that there is something still to be found,
and that more tests are needed.
What can I do to help myself?
- Tackle other stresses that might be
affecting how you feel
- Make your life healthier - if you feel
generally healthier, you may find that your symptoms bother you
- Take regular exercise – it can help to
strengthen muscles and generally make us more fit, but don’t overdo
- Find time to relax.
When might I need treatment for my symptoms?
Most people who see a doctor with medically
unexplained symptoms are helped by talking about how their symptoms
are caused and what they can do to help themselves. If this
isn’t effective, your doctor might suggest other
There are different types of talking therapies
that can help. The choice of therapy depends upon the sort of
problem and what therapies are available.
Antidepressants are used
to treat a range of problems, not just depression, and can help
treat medically unexplained symptoms.
Will I get better?
Even if you have had symptoms for a long time,
there is much that can be done to help you live a better life and
to avoid unnecessary treatments or investigations.
This leaflet was produced by the Royal College
of Psychiatrists Public Education Editorial Board and the Faculty
of Liaison Psychiatry.
Series Editor: Dr Philip Timms
Authors: Dr Jim Bolton & Dr D Attard
© June 2015. Due for review: June
2018. Royal College of Psychiatrists.
This is an abridged version of our main
leaflet on 'Medical Unexplained Symptoms'. You can link to,
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