Physical symptoms which are not caused by physical disease or injury are very common, and can become very distressing and disabling. They can be caused by over-use (e.g. ‘cramp’ or tiredness) or over-breathing (e.g. ‘pins and needles’ or giddiness) but are usually explained by natural physiological processes.1 They are often explainable by reference to very well established physiological explanations of stress on the body, e.g. lactate build-up in muscles with over-use or acid-base imbalances from hyperventilation causing giddiness or tingling. They can be a result of an interaction between the physical trigger for the symptoms (e.g. a virus or an acute injury) and an individual’s cognitive, behavioural and emotional responses which may perpetuate these symptoms. Many patients with these symptoms meet criteria for a recognised syndrome such as chronic fatigue syndrome, irritable bowel syndrome, non-cardiac chest pain and fibromyalgia. They can also be a result of anxiety or depression which needs treatment in its own right.
Describing these symptoms as medically unexplained is incorrect, confusing and even frightening to those experiencing and not understanding them – more empowering, recovery-focused approaches are evidence-based.
Why specific symptoms occur may be explained by the context and prior experience of the person concerned – so may have psychological significance e.g. the interpretation of chest pain as due to a heart attack when a close relative has recently died of this. Persistent and more severe symptoms – often referred to as somatoform disorders – can benefit from intervention, e.g. cognitive behaviour therapy or graded exercise therapy, and even more complex ones from liaison services.