Medically unexplained symptoms (MUS) is a diagnosis that's made when you have persistent physical problems, such as headaches, dizziness or pain, which don’t seem to match any recognised medical condition.
All medical disorders have both physical and psychological causes. Our state of mind has an important influence on how we experience physical illness. Symptoms of common physical disorders, such as asthma, diabetes or arthritis, are strongly influenced by our mental state. Our state of mind has an impact on our immune system and on the levels of hormones such as cortisol in our bodies.
Being diagnosed with MUS is not uncommon, with around a quarter of people visiting GPs expressing symptoms which can’t immediately be diagnosed as a recognised medical condition. This doesn’t mean that your situation can't be treated; it requires looking beyond a diagnosis of physical illness.
While initial diagnoses may conclude that you have MUS, further physical examinations or psychological assessments can ultimately help to determine whether there are existing physical or mental health conditions that are the reason behind your physical complaints.
Physical diagnoses which may be given for MUS include:
Mental health diagnoses which may be given for MUS include:
Where excessive concern about physical aspects of your body cause severe distress and impacts on daily functioning.
Physical symptoms such as fits and loss of memory, which seem to be caused by problems in your nervous system, but are actually brought on by excessive stress.
A group of psychological disorders where physical symptoms are experienced as a result of stress, usually lasting a long time.
Physical symptoms without a diagnosed cause are very distressing. The pain experienced is as real and as distressing as pain from any other cause, as is the lethargy. These symptoms often result in secondary depression and anxiety, and saying that these symptoms are ‘all in your head’ is both incorrect and unhelpful.
CBT uses problem solving techniques to help you understand and manage your symptoms, as well as working through how mental health conditions such as anxiety and depression could be causing your physical complaints. Through learning new methods of coping with distress and worry, it's possible that the physical pain that's associated with your diagnosis will begin to improve.
Mindfulness is accepted as an additional treatment to CBT for reducing the symptoms of MUS. This involves elements of CBT, with the addition of current psychological methods that can teach you to be present in the moment, as opposed to dwelling on what may or may not happen in the future.
Using breathing and meditation techniques, you'll begin to learn how to clear your mind of negative thoughts, which may be contributing to the preoccupation and health anxiety that's experienced if you have MUS.
Behavioural activation is a focused way of scheduling activities and creating positive routines each day. It's believed that a more positive frame of mind can improve your self-confidence and sense of wellbeing, thereby contributing to an improvement in symptoms and a proactive approach to facing life’s challenges.
EMDR is a psychotherapy technique that helps people to process distressing memories and past trauma. EMDR can therefore be a useful way of treating MUS as it can help you to explore potential psychological factors that may be contributing to your current physical symptoms. EMDR can help to address past traumas or stressors, restructure unhealthy thought patterns, regulate emotions, build resilience and enhance body awareness.
DBT skills can also be helpful when it comes to treating MUS as it helps people to manage emotional distress, improve coping skills and enhance self-awareness. Skills taught in DBT, such as mindfulness, emotion regulation and distress tolerance can help people to recognise and manage the emotional and psychological factors that may be contributing to their MUS. By learning to regulate emotions effectively, tolerate distress, and improve communication in relationships, people can experience a reduction in the intensity and frequency of the physical symptoms they're currently experiencing.
Particularly if your symptoms of depression and anxiety are chronic, medication may be used alongside psychotherapy to help to improve MUS.
Selective serotonin reuptake inhibitors (SSRIs) can be used, as can other antidepressants and anxiolytics. These reduce both depression and anxiety.
There are several reasons why you may be diagnosed with MUS, despite there being no clear link to a physical condition that matches your symptoms. It's important to recognise that stressful life events, worries, and mental health conditions such as anxiety and depression can manifest in the form of physical complaints, despite appearing to be based only in your mind.
The intrinsic connection between your mind and body means that when your mind is affected by stress, anxiety or depression, it's the physical symptoms of these conditions that are initially most apparent. For this reason, you may not be aware that you have anxiety or depression, instead remaining focused on the physical symptoms which you may believe are due to a physical cause.
Some of the physical symptoms that you may experience when you have anxiety, depression or high levels of stress include:
Rapid heartbeat and palpitations, breathlessness, tremors, dry mouth, chest tightness and neck stiffness are some of the associated symptoms of anxiety.
When you're feeling depressed, your tolerance to physical pain is lower. Symptoms relating to the mental and emotional side of the condition include extreme sadness and feelings of hopelessness, although your body can react in the form of physical complaints such as loss of appetite, loss of weight, low energy and general aches and pains.
We've evolved to respond to stress in a way that means we're ready for physical action of some kind. Periods of increased stress, such as following a bereavement, or problems relating to money, relationships, or your job, can cause a physical reaction in your body. This heightened energy response can cause headaches, muscle tension, and feelings of nausea and dizziness, which can make you feel particularly uncomfortable.
You may naturally worry more about your physical health than other people, and this can cause you to overanalyse your symptoms to the extent that it causes your physical complaints to worsen. This may happen for several reasons, including:
It's believed that women are more affected than men by MUS, with reasons for this at least partially explained by women being more likely to seek help and support for MUS, while men are less likely to report physical symptoms until their symptoms worsen. MUS is also common amongst young people. Having a recent infection, physical illness, or experiencing a stressful life event can mean that you're more likely to be diagnosed with MUS.
If you have existing problems with anxiety, depression or stress, or are generally someone who has extreme reactions to distress, then you're more likely to receive a diagnosis of MUS. Associated symptoms of these mental health conditions and their associated pressures on your mental wellbeing can also manifest in the form of physical symptoms, with a link to mental health not always being made in the first instance.
If you believe that you may be experiencing symptoms of MUS, help and support is available at Priory. Using a bespoke treatment plan aimed at treating the psychological impact on MUS, our specialised consultants and therapists will help you work towards reducing the impact that MUS has on your life.
