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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Medically Unexplained Symptoms: key facts

 

Introduction

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. 

 

Medically unexplained symptoms

What sorts of symptoms can be medically unexplained?

The commonest such symptoms include:

  • pains in the back, muscles or joints
  • headaches
  • tiredness
  • feeling faint
  • chest pain or heart palpitations
  • stomach problems.

What causes medically unexplained symptoms?

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 body

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 and software

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.  

 

  • Being “out of tune”

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 palpitations
  • chest tightness and breathlessness
  • dizziness, faintness and feeling light headed
  • indigestion, feeling sick, diarrhoea
  • tightness in the throat
  • muscle tension and headaches.

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 long time.  

 

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 worse.  

 

Being ill with anxiety or depression can cause bodily symptoms

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 above.

 

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 pains.

 

Can I have a physical illness and medically unexplained symptoms?

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 less.  
  • Take regular exercise – it can help to strengthen muscles and generally make us more fit, but don’t overdo it.
  • 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 treatments. 

 

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 2013. Due for review: June 2015. Royal College of Psychiatrists. This is an abridged version of our main leaflet on 'Medical Unexplained Symptoms'. You can link to, download, print, photocopy this leaflet free of charge. You must not change it or repost it on a website. For further information, contact permissions@rcpsych.ac.uk.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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