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Neurosci Biobehav Rev. 2017 Mar;74(Pt A):185-203. doi: 10.1016/j.neubiorev.2017.01.015. Epub 2017 Jan 17.

Symptoms and the body: Taking the inferential leap.

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Health Psychology, University of Leuven, Tiensestraat 102, Belgium. Electronic address:
Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Germany.
Health Psychology, University of Leuven, Tiensestraat 102, Belgium; Institute for Health and Behaviour, University of Luxembourg, Luxembourg and Health Psychology, University of Leuven, Belgium.
Centre for New Treatments and Understanding in Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, UK; Psychological Services, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Sciences Centre, UK.


The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.


Medically unexplained symptoms; Predictive coding; Symptom perception

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