2nd February 2024

Background

Physical symptoms can be painful or cause some distress. They can happen anywhere in our body and at any period. One would generally be able to identify the complaints and investigate efficiently to conclude the diagnosis and the reason for the pain. Sometimes, this distress might need treatment or subside on its own.

There can be times when a physical cause cannot be found, or even blood investigations and radiology might be of no help. These physical symptoms are called “Medically unexplained symptoms” (MUS). There is generally no known physical cause to explain the symptoms.

These individuals would principally present on the medical wards rather than in a mental health setting. It is inappropriate to label an individual as having a mental illness just because there is no medical explanation; nevertheless, there is a possibility that there may be a co-morbid illness aside from the medical illness.

Epidemiology

MUS accounts for 20-25 % of presentations in primary care. The figure increases to 33% in a Neurological setting. 

This leads to significant anguish, impaired functioning and impacts an individual’s day-to-day functioning, reducing their productivity and quality of life. The trust and confidence in the treating team eventually drop as they feel their concerns are not taken into consideration. Likewise, the treating team can feel frustrated and unsatisfied due to the difficulty in understanding and supporting such patients. 

One-tenth of NHS expenditure spent on the working population in England has been accounted for in the management of MUS.

Understanding Mind-Body Dualism

There is a dichotomous view or black-and-white thinking that an illness can be either medical or psychiatric. This is clinically valid in that they are two different entities. However, there is an intimate causal relationship between the two. The mind-body connection is the link between a person’s cognition and physical health. It is one’s thoughts, feelings, expectations, emotions, attitude and behaviour in response to these cognitions and physical health.

Theoretically, one can argue that the body and mind cannot exist separately. Clinically, there is an assumption that bodily symptoms always indicate bodily pathology, that mental illness demonstrates some psychopathology, and that they cannot coexist. Confusion arises especially when there are bodily symptoms without bodily pathology.

When someone is stressed at work, they experience a headache, back pain or shoulder pain. When embarrassed, they blush or experience a flush on the face. These are simple examples of mind and body interconnection where the mind influences the body.

There is no clear-cut distinction or line between physical and mental illness. For example, 20% of those with non-epileptic attack disorder may also have epilepsy. Likewise, panic disorder and chest pain can occur frequently following a heart attack.

Both mental and physical illness can, of course, also coexist. Studies say that around half of patients with MUS might be suffering from anxiety and depression. It could be both a causative factor and an impact of illness.

References

• A; WTAH. The Diagnostic and statistical manual of mental disorders, fifth edition alternative model of personality disorder [Internet]. Personality disorders. U.S. National Library of Medicine; [cited 2022 Dec 21]. Available from: https://pubmed.ncbi.nlm.nih.gov/35787119/
• RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS. (n.d.). Medically unexplained symptoms. [online] Available at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/medically-unexplained-symptoms
• Academic.oup.com. [cited 2022Dec21]. Available from: https://academic.oup.com/book/41095/chapter/351140684 
• DS; IMLP. Medically unexplained symptoms [Internet]. The Medical clinics of North America. U.S. National Library of Medicine; [cited 2022 Dec 21]. Available from: https://pubmed.ncbi.nlm.nih.gov/24758967/ 
• Medically unexplained symptoms: Royal College of Psychiatrists [Internet]. www.rcpsych.ac.uk. [cited 2022Dec21]. Available from: https://www.rcpsych.ac.uk/mental-health/problems-disorders/medically-unexplained-symptoms