Understanding medically unexplained symptoms 

For a long time, the medical system has been designed as though the mind and the body are totally separate. If we have a physical symptom that there is no explanation for, we go to the doctor to try to find out what it is. However, for lots of people, the physical symptoms they are experiencing are not easily understood by a diagnosis. They may undergo various different investigations that do not shed any light on what is causing their symptoms. They may be told their symptoms are stress-related, or that they are experiencing health anxiety. This can be confusing, especially if the person does not feel particularly stressed. People can feel very dismissed by doctors, especially those who do not have experience in understanding and managing these symptoms. They can be made to feel as though they are not being believed, or that the doctors think the symptoms are all in their head. This can be disheartening, and it is extremely common. One study found that at least one medically unexplained symptom was present in 50% of all consultations with General Practitioners.

What do medically unexplained symptoms look like?

“Medically unexplained symptoms” is a term that can refer to a wide range of different problems. A broad definition is: physical symptoms that cannot be explained by medical tests. You might hear other terms being used to refer to this problem, such as persistent physical symptoms, functional neurological symptoms or terms like somatic symptom disorder. These terms can be used to describe symptoms that affect lots of different parts of your body. People experiencing medically unexplained symptoms might experience more isolated symptoms like headaches or chest pain, or they may experience problems with their digestive system or bladder/bowels, symptoms relating to their heart and breathing, neurological symptoms like dizziness, weakness, seizures or changes in thinking/memory. Sometimes there may be a collection of symptoms that suggest a particular syndrome such as Irritable Bowel Syndrome. Other poorly understood conditions like chronic fatigue syndrome and fibromyalgia also fall under this category.

As a person who is experiencing these symptoms, It can be incredibly frustrating to undergo multiple rounds of investigation, only for doctors to be able to tell you what is not going on. As a person experiencing these symptoms, you want to get to the bottom of them, so that you can work on managing them or eliminating them. 

We know that psychological and social factors play a role in all physical symptoms, including those that do have a clear medical explanation. For example, two people who are diagnosed with diabetes could experience completely different impacts on their life depending on how they make sense of their diagnosis and how much they stick to the recommended treatment as a result. When medically unexplained symptoms seem to be present, it is always recommended to explore the psychological side of things to understand the role that these are playing for the person. 

Your doctor might suggest that you meet with a psychologist who specialises in these symptoms if they have done all of the recommended tests and the results have not shown a full explanation. They would not suggest this until all possible medical explanations have been ruled out, to make sure that nothing important has been missed. 

How we work with medically unexplained symptoms in psychological therapy?

Our understanding of these problems is developing all the time, but the medical model as a whole has not updated in line with new understandings of how our minds and bodies interact. This is where psychological therapy can offer something really valuable. 

As a psychologist working with these symptoms, my goal is to work with you to better understand the symptoms. We develop an understanding of what is going on in your life as you experience the symptoms, helping us to understand triggers, short and long-term factors that might be feeding into the picture and ways to manage things differently so that we can stop the symptoms from interfering with your life so much. In therapy, we target the “unexplained” part, so that your symptoms become less of a mystery and you leave feeling equipped to handle things differently.

Frequently Asked Questions (FAQ’s) about medically unexplained symptoms

Will therapy get rid of the symptoms?

It’s hard to say. Lots of people do get symptom reduction or relief after attending therapy. However, as there are lots of unknowns, we don’t want to rely too strongly on this as an outcome. Instead, we focus on understanding the symptoms and helping you to manage them better so that you can live your life the way you want to. 

Is it “all in my head”? 

Absolutely not. The symptoms are real physical symptoms and affect you in the same way that anyone who has a health condition is affected by their symptoms. Outdated understandings can lead people to throw around unhelpful phrases like this; it is important that we challenge this so that people experiencing these symptoms can get the specialist support that they need without stigma or misunderstandings getting in the way.

Where can I learn more about medically unexplained symptoms?

There are some fantastic books and resources available on this topic. If you are interested, you can look at: 

• The Royal College of Psychiatrists Information page on medically unexplained symptoms: https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/medically-unexplained-symptoms
• This website, written for patients by an doctor with expertise in this area: www.neurosymptoms.org
• “It’s all in your head” by Dr Suzanne O’Sullivan – a doctor’s account of the real and debilitating effects of medically unexplained symptoms, from her experiences of working with people with these difficulties