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Br J Gen Pract. Mar 2003; 53(488): 231–239.
PMCID: PMC1314551

Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS).


Patients commonly present in primary care with symptoms for which no physical pathology can be found. This study is a review of published research on medically unexplained symptoms (MUPS) in primary care. A literature review and qualitative comparison of information was carried out. Four questions were addressed: what is the prevalence of MUPS; to what extent do MUPS overlap with psychiatric disorder; which psychological processes are important in patients with MUPS; and what interventions are beneficial? Neither somatised mental distress nor somatisation disorders, based on symptom counts, adequately account for most patients seen with MUPS. There is substantial overlap between different symptoms and syndromes, suggesting they have much in common. Patients with MUPS may best be viewed as having complex adaptive systems in which cognitive and physiological processes interact with each other and with their environment. Cognitive behavioural therapy and antidepressant drugs are both effective treatments, but their effects may be greatest when the patient feels empowered by their doctor to tackle their problem.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Campbell SM, Roland MO. Why do people consult the doctor? Fam Pract. 1996 Feb;13(1):75–83. [PubMed]
  • Salmon P, Woloshynowych M, Valori R. The measurement of beliefs about physical symptoms in English general practice patients. Soc Sci Med. 1996 Jun;42(11):1561–1567. [PubMed]
  • Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychother Psychosom. 2000 Jul-Aug;69(4):205–215. [PubMed]
  • Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999 Sep 11;354(9182):936–939. [PubMed]
  • Walker EA, Katon WJ, Jemelka RP, Roy-Bryne PP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) Study. Am J Med. 1992 Jan 24;92(1A):26S–30S. [PubMed]
  • Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988 Nov;145(11):1358–1368. [PubMed]
  • Goldberg DP, Bridges K. Somatic presentations of psychiatric illness in primary care setting. J Psychosom Res. 1988;32(2):137–144. [PubMed]
  • Escobar JI, Gara M, Silver RC, Waitzkin H, Holman A, Compton W. Somatisation disorder in primary care. Br J Psychiatry. 1998 Sep;173:262–266. [PubMed]
  • Katon WJ, Walker EA. Medically unexplained symptoms in primary care. J Clin Psychiatry. 1998;59 (Suppl 20):15–21. [PubMed]
  • Peters S, Stanley I, Rose M, Salmon P. Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care. Soc Sci Med. 1998 Feb-Mar;46(4-5):559–565. [PubMed]
  • Sharpe M, Carson A. "Unexplained" somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med. 2001 May 1;134(9 Pt 2):926–930. [PubMed]
  • Bridges K, Goldberg D. Somatic presentation of depressive illness in primary care. J R Coll Gen Pract Occas Pap. 1987 Sep;(36):9–11. [PMC free article] [PubMed]
  • Kiecolt-Glaser Janice K, McGuire Lynanne, Robles Theodore F, Glaser Ronald. Psychoneuroimmunology and psychosomatic medicine: back to the future. Psychosom Med. 2002 Jan-Feb;64(1):15–28. [PubMed]
  • Mumford DB, Devereux TA, Maddy PJ, Johnston JV. Factors leading to the reporting of 'functional' somatic symptoms by general practice attenders. Br J Gen Pract. 1991 Nov;41(352):454–458. [PMC free article] [PubMed]
  • Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997 Mar;42(3):245–252. [PubMed]
  • Escobar JI, Waitzkin H, Silver RC, Gara M, Holman A. Abridged somatization: a study in primary care. Psychosom Med. 1998 Jul-Aug;60(4):466–472. [PubMed]
  • Kirmayer LJ, Robbins JM. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis. 1991 Nov;179(11):647–655. [PubMed]
  • Kisely S, Goldberg D, Simon G. A comparison between somatic symptoms with and without clear organic cause: results of an international study. Psychol Med. 1997 Sep;27(5):1011–1019. [PubMed]
  • Fink P, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics. 1999 Jul-Aug;40(4):330–338. [PubMed]
  • Gara MA, Silver RC, Escobar JI, Holman A, Waitzkin H. A hierarchical classes analysis (HICLAS) of primary care patients with medically unexplained somatic symptoms. Psychiatry Res. 1998 Oct 19;81(1):77–86. [PubMed]
  • Robbins JM, Kirmayer LJ, Hemami S. Latent variable models of functional somatic distress. J Nerv Ment Dis. 1997 Oct;185(10):606–615. [PubMed]
  • Liu G, Clark MR, Eaton WW. Structural factor analyses for medically unexplained somatic symptoms of somatization disorder in the Epidemiologic Catchment Area study. Psychol Med. 1997 May;27(3):617–626. [PubMed]
  • Deary IJ. A taxonomy of medically unexplained symptoms. J Psychosom Res. 1999 Jul;47(1):51–59. [PubMed]
  • Craig TK, Drake H, Mills K, Boardman AP. The South London Somatisation Study. II. Influence of stressful life events, and secondary gain. Br J Psychiatry. 1994 Aug;165(2):248–258. [PubMed]
  • Hotopf M, Mayou R, Wadsworth M, Wessely S. Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. Am J Psychiatry. 1999 Nov;156(11):1796–1800. [PubMed]
  • Cameron L, Leventhal EA, Leventhal H. Seeking medical care in response to symptoms and life stress. Psychosom Med. 1995 Jan-Feb;57(1):37–47. [PubMed]
  • Fry RP, Crisp AH, Beard RW. Sociopsychological factors in chronic pelvic pain: a review. J Psychosom Res. 1997 Jan;42(1):1–15. [PubMed]
  • Hotopf M, Mayou R, Wadsworth M, Wessely S. Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort. Br J Psychiatry. 1998 Sep;173:255–261. [PubMed]
  • Garcia-Campayo J, Sanz-Carrillo C. A review of the differences between somatizing and psychologizing patients in primary care. Int J Psychiatry Med. 1999;29(3):337–345. [PubMed]
  • Kirmayer LJ, Robbins JM. Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychol Med. 1996 Sep;26(5):937–951. [PubMed]
  • Cape J, McCulloch Y. Patients' reasons for not presenting emotional problems in general practice consultations. Br J Gen Pract. 1999 Nov;49(448):875–879. [PMC free article] [PubMed]
  • Bower P, West R, Tylee A, Hann M. Symptom attribution and the recognition of psychiatric morbidity. J Psychosom Res. 2000 Feb;48(2):157–160. [PubMed]
  • Jyväsjärvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä SL, Keinänen-Kiukaanniemi S. Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care. Compr Psychiatry. 1999 Jul-Aug;40(4):292–298. [PubMed]
  • Little P, Somerville J, Williamson I, Warner G, Moore M, Wiles R, George S, Smith A, Peveler R. Psychosocial, lifestyle, and health status variables in predicting high attendance among adults. Br J Gen Pract. 2001 Dec;51(473):987–994. [PMC free article] [PubMed]
  • Noyes R, Jr, Langbehn DR, Happel RL, Sieren LR, Muller BA. Health Attitude Survey. A scale for assessing somatizing patients. Psychosomatics. 1999 Nov-Dec;40(6):470–478. [PubMed]
  • MacLeod AK, Haynes C, Sensky T. Attributions about common bodily sensations: their associations with hypochondriasis and anxiety. Psychol Med. 1998 Jan;28(1):225–228. [PubMed]
  • Pilowsky I, Smith QP, Katsikitis M. Illness behaviour and general practice utilisation: a prospective study. J Psychosom Res. 1987;31(2):177–183. [PubMed]
  • Speckens AE, Spinhoven P, Sloekers PP, Bolk JH, van Hemert AM. A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. J Psychosom Res. 1996 Jan;40(1):95–104. [PubMed]
  • Speckens AE, Van Hemert AM, Spinhoven P, Bolk JH. The diagnostic and prognostic significance of the Whitely Index, the Illness Attitude Scales and the Somatosensory Amplification Scale. Psychol Med. 1996 Sep;26(5):1085–1090. [PubMed]
  • Barsky AJ, Ahern DK, Bailey ED, Delamater BA. Predictors of persistent palpitations and continued medical utilization. J Fam Pract. 1996 May;42(5):465–472. [PubMed]
  • Barsky AJ, Barnett MC, Cleary PD. Hypochondriasis and panic disorder. Boundary and overlap. Arch Gen Psychiatry. 1994 Nov;51(11):918–925. [PubMed]
  • Sensky T, MacLeod AK, Rigby MF. Causal attributions about common somatic sensations among frequent general practice attenders. Psychol Med. 1996 May;26(3):641–646. [PubMed]
  • Robbins JM, Kirmayer LJ. Transient and persistent hypochondriacal worry in primary care. Psychol Med. 1996 May;26(3):575–589. [PubMed]
  • Mabeck CE, Olesen F. Metaphorically transmitted diseases. How do patients embody medical explanations? Fam Pract. 1997 Aug;14(4):271–278. [PubMed]
  • Williams S, Weinman J, Dale J, Newman S. Patient expectations: what do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995 Jun;12(2):193–201. [PubMed]
  • Salmon P, Peters S, Stanley I. Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ. 1999 Feb 6;318(7180):372–376. [PMC free article] [PubMed]
  • Simon GE, Gureje O. Stability of somatization disorder and somatization symptoms among primary care patients. Arch Gen Psychiatry. 1999 Jan;56(1):90–95. [PubMed]
  • García-Campayo J, Larrubia J, Lobo A, Pérez-Echeverría MJ, Campos R. Attribution in somatizers: stability and relationship to outcome at 1-year follow-up. Grupo Morbilidad Psiquica y Psicosomática de Zaragoza (GMPPZ). Acta Psychiatr Scand. 1997 May;95(5):433–438. [PubMed]
  • van Dulmen AM, Fennis JF, Mokkink HG, Bleijenberg G. The relationship between complaint-related cognitions in referred patients with irritable bowel syndrome and subsequent health care seeking behaviour in primary care. Fam Pract. 1996 Feb;13(1):12–17. [PubMed]
  • Potts SG, Bass CM. Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study. Psychol Med. 1995 Mar;25(2):339–347. [PubMed]
  • Lucock MP, Morley S, White C, Peake MD. Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey. BMJ. 1997 Sep 6;315(7108):572–575. [PMC free article] [PubMed]
  • Coia P, Morley S. Medical reassurance and patients' responses. J Psychosom Res. 1998 Nov;45(5):377–386. [PubMed]
  • Neal RD, Heywood PL, Morley S. 'I always seem to be there'--a qualitative study of frequent attenders. Br J Gen Pract. 2000 Sep;50(458):716–723. [PMC free article] [PubMed]
  • Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ. 1997 Aug 9;315(7104):350–352. [PMC free article] [PubMed]
  • Morriss RK, Gask L, Ronalds C, Downes-Grainger E, Thompson H, Goldberg D. Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners. Br J Gen Pract. 1999 Apr;49(441):263–267. [PMC free article] [PubMed]
  • Morriss R, Gask L, Ronalds C, Downes-Grainger E, Thompson H, Leese B, Goldberg D. Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs. Fam Pract. 1998 Apr;15(2):119–125. [PubMed]
  • Downes-Grainger E, Morriss R, Gask L, Faragher B. Clinical factors associated with short-term changes in outcome of patients with somatized mental disorder in primary care. Psychol Med. 1998 May;28(3):703–711. [PubMed]
  • Lidbeck J. Group therapy for somatization disorders in general practice: effectiveness of a short cognitive-behavioural treatment model. Acta Psychiatr Scand. 1997 Jul;96(1):14–24. [PubMed]
  • McLeod CC, Budd MA, McClelland DC. Treatment of somatization in primary care. Gen Hosp Psychiatry. 1997 Jul;19(4):251–258. [PubMed]
  • Speckens AE, van Hemert AM, Spinhoven P, Hawton KE, Bolk JH, Rooijmans HG. Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. BMJ. 1995 Nov 18;311(7016):1328–1332. [PMC free article] [PubMed]
  • Guthrie E, Creed F, Dawson D, Tomenson B. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br J Psychiatry. 1993 Sep;163:315–321. [PubMed]
  • Schilte AF, Portegijs PJ, Blankenstein AH, van Der Horst HE, Latour MB, van Eijk JT, Knottnerus JA. Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care. BMJ. 2001 Jul 14;323(7304):86–86. [PMC free article] [PubMed]
  • O'Malley PG, Jackson JL, Santoro J, Tomkins G, Balden E, Kroenke K. Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Pract. 1999 Dec;48(12):980–990. [PubMed]
  • Donovan JL, Blake DR. Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?". BMJ. 2000 Feb 26;320(7234):541–544. [PMC free article] [PubMed]
  • Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001 Oct 20;323(7318):908–911. [PMC free article] [PubMed]
  • Melville DI. Descriptive clinical research and medically unexplained physical symptoms. J Psychosom Res. 1987;31(3):359–365. [PubMed]
  • Pålsson N. Functional somatic symptoms and hypochondriasis among general practice patients: a pilot study. Acta Psychiatr Scand. 1988 Aug;78(2):191–197. [PubMed]
  • Scicchitano J, Lovell P, Pearce R, Marley J, Pilowsky I. Illness behavior and somatization in general practice. J Psychosom Res. 1996 Sep;41(3):247–254. [PubMed]
  • Posse M, Hällström T. Depressive disorders among somatizing patients in primary health care. Acta Psychiatr Scand. 1998 Sep;98(3):187–192. [PubMed]
  • Lobo A, Garcia-Campayo J, Campos R, Marcos G, Perez-Echeverria MJ. Somatisation in primary care in Spain: I. Estimates of prevalence and clinical characteristics. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza. Br J Psychiatry. 1996 Mar;168(3):344–348. [PubMed]
  • Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ. Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. 1993 May;150(5):734–741. [PubMed]
  • Munk-Jørgensen P, Fink P, Brevik JI, Dalgard OS, Engberg M, Hansson L, Holm M, Joukamaa M, Karlsson H, Lehtinen V, et al. Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment. Acta Psychiatr Scand. 1997 Jan;95(1):6–12. [PubMed]
  • Feder A, Olfson M, Gameroff M, Fuentes M, Shea S, Lantigua RA, Weissman MM. Medically unexplained symptoms in an urban general medicine practice. Psychosomatics. 2001 May-Jun;42(3):261–268. [PubMed]
  • Weich S, Lewis G, Donmall R, Mann A. Somatic presentation of psychiatric morbidity in general practice. Br J Gen Pract. 1995 Mar;45(392):143–147. [PMC free article] [PubMed]

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