Medically Unexplained Symptoms

doi:10.1017/9781911623038.011

Chapter 10 - Medically Unexplained Symptoms

from Section 2 - Clinical Issues

Published online by Cambridge University Press: 10 September 2018

Christopher Dowrick and

Marianne Rosendal

Edited by

Linda Gask ,

Tony Kendrick ,

Robert Peveler and

Carolyn A. Chew-Graham

Show author details

Linda Gask: Affiliation:
University of Manchester
Tony Kendrick: Affiliation:
University of Southampton
Robert Peveler: Affiliation:
University of Southampton
Carolyn A. Chew-Graham: Affiliation:
Keele University

Book contents

Get access

Type: Chapter
Information: Primary Care Mental Health , pp. 138 - 152

DOI: https://doi.org/10.1017/9781911623038.011 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn.). American Psychiatric Publishing.Google Scholar

Arnold, I, de Waal, M, Eekhof, J, et al. (2006) Somatoform disorder in primary care: course and the need for cognitive–behavioral treatment. Psychosomatics, 47, 498–503.Google Scholar

Blumenfield, M, Strain, J (2006) Psychosomatic Medicine. Lippincott Williams & Wilkins.Google Scholar

Budtz-Lilly, A, Fink, P, Ørnbøl, E, et al. (2015a) A new questionnaire to identify bodily distress in primary care: the ‘BDS checklist’. Journal of Psychosomatic Research, 78, 536–545.Google Scholar

Budtz-Lilly, A, Vestergaard, M, Fink, P, et al. (2015b) The prognosis of bodily distress syndrome: a cohort study in primary care. General Hospital Psychiatry, 37, 560–566.Google Scholar

Budtz-Lilly, A, Vestergaard, M, Fink, P, et al. (2015c) Patient characteristics and frequency of bodily distress syndrome in primary care: a cross-sectional study. British Journal of General Practice, 65, e617–e623.Google Scholar

Burton, C, McGorm, K, Richardson, G, et al. (2012) Healthcare costs incurred by patients repeatedly referred to secondary medical care with medically unexplained symptoms: a cost of illness study. Journal of Psychosomatic Research, 72, 242–247.Google Scholar

Cagnie, B, Coppieters, I, Denecker, S, et al. (2014) Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Seminars in Arthritis and Rheumatology, 44, 68–75.Google Scholar

Carson, A, Best, S, Postma, K, et al. (2003) The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. Journal of Neurology Neurosurgery and Psychiatry, 74, 897–900.Google Scholar

Chew-Graham, C (2005) Why do doctors feel pressurised? Journal of Psychosomatic Medicine, 59, 261–262.Google Scholar

Chew-Graham, C, May, C, Roland, M (2004) The harmful consequences of elevating the doctor–patient relationship to be the primary goal of the general practice consultation. Family Practice, 21, 229–231.Google Scholar

Creed, F, Davies, I, Jackson, J, et al. (2012) The epidemiology of multiple somatic symptoms. Journal of Psychosomatic Research, 72, 311–317.Google Scholar

de Waal, M, Arnold, I, Eekhof, J (2004) Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. British Journal of Psychiatry, 184, 470–476.CrossRef Google Scholar PubMed

Dowrick, (2009) Beyond Depression (2nd edn.). Oxford University Press.Google Scholar

Dowrick, C, Ring, A, Humphris, G, et al. (2004) Normalisation of unexplained symptoms by general practitioners: a functional typology. British Journal of General Practice, 54, 165–170.Google Scholar

Elnegaard, S, Andersen, R, Pedersen, A, et al. (2015) Self-reported symptoms and healthcare seeking in the general population–exploring ‘The Symptom Iceberg’. BMC Public Health, 15, 685.CrossRef Google Scholar PubMed

Escobar, J, Gara, M, Diaz-Martinez, A, et al. (2007) Effectiveness of a time-limited cognitive behavior therapy-type intervention among primary care patients with medically unexplained symptoms. Annals of Family Medicine, 5, 328–335.Google Scholar

Ferrari, R (2004). The clinical relevance of symptom amplification. Pain, 107, 276–277.CrossRef Google Scholar PubMed

Fink, P, Rosendal, M, Schroder, A, et al. (2015) Functional Disorders and Medically Unexplained Symptoms. Assessment and Treatment. Aarhus University Press.Google Scholar

Fink, P, Rosendal, M, Toft, T (2002) Assessment and treatment of functional disorders in general practice: the extended reattribution and management model – an advanced educational program for nonpsychiatric doctors. Psychosomatics, 43, 93–131.Google Scholar

Fink, P, Schroder, A (2010) The single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. Journal of Psychosomatic Research, 68, 415–426.CrossRef Google Scholar PubMed

Fink, P, Toft, T, Hansen, M, et al. (2007) Symptoms and syndromes of bodily distress. An explorative study among 978 internal medical, neurological and primary care patients. Psychosomatic Medicine, 69, 30–39.Google Scholar

Frostholm, L, Ornbøl, E, Hansen, H, et al. (2010) Which is more important for outcome: the physician’s or the patient’s understanding of a health problem? A 2-year follow-up study in primary care. General Hospital Psychiatry, 32, 1–8.Google Scholar

Gask, L, Dowrick, C, Salmon, P, et al. (2011) Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. Journal of Psychosomatic Research, 71, 325–334.Google Scholar

Hatcher, S, House, A (2003) Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case–control study. Psychological Medicine, 33, 1185–1192.Google Scholar

Henningsen, P, Zipfel, S, Herzog, W (2007) Management of functional somatic syndromes. Lancet, 369, 946–955.Google Scholar

Jackson, J, Fiddler, M, Kapur, N, et al. (2006) Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics. Journal of Psychosomatic Research, 60, 357–363.CrossRef Google Scholar PubMed

Jackson, J, Passamonti, M (2005) The outcomes among patients presenting in primary care with a physical symptom at 5 years. Journal of General Internal Medicine, 20, 1032–1037.Google Scholar

Kato, K, Sullivan, P, Evengard, B, et al. (2006) Premorbid predictors of chronic fatigue. Archives of General Psychiatry, 63, 1267–1272.CrossRef Google Scholar PubMed

Kendrick, D, Fielding, K, Bentley, E, et al. (2001) Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. British Medical Journal, 322, 400–405.Google Scholar

Kennedy, A, Nelson, E, Reeves, D, et al. (2003) A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self-help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease. Health Technology Assessment, 7, 1–113.Google Scholar

Konnopka, A, Kaufmann, C, König, H, et al. (2013) Association of costs with somatic symptom severity in patients with medically unexplained symptoms. Journal of Psychosomatic Research, 75, 370–375.Google Scholar

Körber, S, Frieser, D, Steinbrecher, N, et al. (2011) Classification characteristics of the Patient Health Questionnaire-15 for screening somatoform disorders in a primary care setting. Journal of Psychosomatic Research, 71, 142–147.CrossRef Google Scholar

Kroenke, K, Mangelsdorff, A (1989) Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262–266.Google Scholar

Kroenke, K, Swindle, R (2000) Cognitive–behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics, 69, 205–215.Google Scholar

Lam, T, Goldberg, D, Dowell, A, et al. (2013) Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Family Practice, 30, 76–87.Google Scholar

Lieb, R, Zimmermann, P, Friis, R, et al. (2002) The natural course of DSM–IV somatoform disorders and syndromes among adolescents and young adults: a prospective-longitudinal community study. European Psychiatry, 17, 321–331.Google Scholar

Mayou, R (2014) Is the DSM-5 chapter on somatic symptom disorder any better than DSM-IV somatoform disorder? British Journal of Psychiatry, 204,418–419.Google Scholar

McAteer, A, Elliott, A, Hannaford, P (2011) Ascertaining the size of the symptom iceberg in a UK-wide community-based survey. British Journal of General Practice, 61, e1-11.Google Scholar

Miller, L (1984) Neuropsychological concepts of somatoform disorders. International Journal of Psychiatry in Medicine, 14, 31–46.Google Scholar

Morriss, R, Dowrick, C, Salmon, P, et al. (2007) Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. British Journal of Psychiatry, 191, 536–542.Google Scholar

Nimnuan, C, Rabe-Hesketh, S, Wessely, S, et al. (2001) How many functional somatic syndromes? Journal of Psychosomatic Research, 51, 549–557.Google Scholar

Olde Hartman, T, Borghuis, M, Lucassen, P, et al. (2009) Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363–377.Google Scholar

O’Malley, P, Jackson, J, Santoro, J, et al. (1999) Antidepressant therapy for unexplained symptoms and symptom syndromes. Journal of Family Practice, 48, 980–990.Google Scholar

Peters, S, Rogers, A, Salmon, P, et al. (2009) What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. Journal of General Internal Medicine, 24, 443–449.Google Scholar

Peters, S, Stanley, I, Rose, M, et al. (1998) Patients with medically unexplained symptoms: sources of patients’ authority and implications for demands on medical care. Social Science and Medicine, 46, 559–565.CrossRef Google Scholar PubMed

Rask, M, Oernboel, E, Rosendal, M, Fink, P (2017) Long-term outcome of bodily distress syndrome in primary care: a follow-up study on healthcare costs, work disability, and self-rated health. Psychosomatic Medicine, 79, 346-357Google Scholar

Rask, M, Rosendal, M, Fenger-Gron, M, et al. (2015) Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. General Hospital Psychiatry, 37, 53–59.CrossRef Google Scholar PubMed

Rief, W, Shaw, R, Fichter, M (1998) Elevated levels of psychophysiological arousal and cortisol in patients with somatization syndrome. Psychosomatic Medicine, 60, 198–203.Google Scholar

Ring, A, Dowrick, C, Humphris, G, et al. (2005) The somatizing effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Social Science and Medicine, 61, 1505–1515.Google Scholar

Rosendal, M, Blankenstein, A, Morriss, R, et al. (2013) Enhanced care by generalists for functional somatic symptoms and disorders in primary care. Cochrane Database of Systematic Reviews, CD008142.Google Scholar

Rosendal, M, Olde Hartman, T, Aamland, A, et al. (2017) ‘Medically unexplained’ symptoms and symptom disorders in primary care: prognosis-based recognition and classification. BMC Family Practice, 18, 18.Google Scholar

Rosendal, M, Olesen, F, Fink, P, et al. (2007) A randomized controlled trial of brief training in assessment and treatment of somatisation in primary care: effects on patient outcome. General Hospital Psychiatry, 29, 364–373.Google Scholar

Salmon, P (2006) The potentially somatizing effect of clinical consultation. CNS Spectrums, 11, 190–200.Google Scholar

Salmon, P, Peters, S, Stanley, I (1999) Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis. British Medical Journal, 318, 372–376.Google Scholar

Salmon, P, Ring, A, Dowrick, C, et al. (2005) What do general practice patients want when they present medically unexplained symptoms? Journal of Psychosomatic Research, 59, 255–260.Google Scholar

Schaefert, R, Kaufmann, C, Wild, B, et al. (2013) Specific collaborative group intervention for patients with medically unexplained symptoms in general practice: a cluster randomized controlled trial. Psychotherapy and Psychosomatics, 82, 106–119.Google Scholar

Simon, G, VonKorff, M, Picinnelli, M, et al. (1999) An international study of the relationship between somatic symptoms and depression. New England Journal of Medicine, 341, 1329–1335.Google Scholar

Smith, R, Lyles, J, Gardiner, J, et al. (2006) Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. Journal of General Internal Medicine, 21, 671–677.Google Scholar

Steinbrecher, N, Hiller, W (2011) Course and prediction of somatoform disorder and medically unexplained symptoms in primary care. General Hospital Psychiatry, 33, 318–326.Google Scholar

Taylor, R, Marshall, T, Mann, A, et al. (2012) Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychological Medicine, 42, 855–864.Google Scholar

Theorell, T, Blomkvist, V, Lindh, G, et al. (1999) Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis. Psychosomatic Medicine, 61, 304–310.Google Scholar

Toft, T, Fink, P, Oernboel, E, et al. (2005) Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study. Psychological Medicine, 35, 1175–1184.Google Scholar

Tomenson, B, Essau, C, Jacobi, F, et al. (2013) EURASMUS Population Based Study Group. Total somatic symptom score as a predictor of health outcome in somatic symptom disorders. British Journal of Psychiatry, 203, 373–380.Google Scholar

Tyrer, H, Ali, L, Cooper, F, et al. (2013) The Schedule for Evaluating Persistent Symptoms (SEPS): a new method of recording medically unexplained symptoms. International Journal of Social Psychiatry, 59, 281–287.Google Scholar

Tzellos, T, Toulis, K, Goulis, D, et al. (2010) Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis. Journal of Clinical Pharmacology and Therapeutics, 35, 639–656.Google Scholar

Valentin, G, Pilegaard, M, Vaegter, H, et al. (2016) Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies. BMJ Open, 6, e007616.Google Scholar

White, P, Goldsmith, K, Johnson, A, et al. (2011) Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet, 377, 823–836.Google Scholar

Wileman, L, May, C, Chew-Graham, C (2002) Medically unexplained symptoms and the problem of power in the consultation: a qualitative study. Family Practice, 19, 178–182.Google Scholar

World Health Organization (1992) International Classification of Diseases (10th revision) (ICD-10). World Health Organization.Google Scholar

World Organization of Family Doctors (WONCA) (2005) International Classification of Primary Care (2nd edn.) (ICPC–2–R). Oxford University Press.Google Scholar

Yunus, M (2015) Editorial review: an update on central sensitivity syndromes and the issues of nosology and psychobiology. Current Rheumatology Review, 11, 70–85.Google Scholar

Book contents

Chapter 10 - Medically Unexplained Symptoms

Access options

References

Further Reading and E-resources

References

Save book to Kindle

Save book to Dropbox

Save book to Google Drive