Psychological Approaches to Medically Unexplained Symptoms

doi:10.1017/9781108686976.019

Chapter 17 - Psychological Approaches to Medically Unexplained Symptoms

from Section 1 - Psychological and Psychodynamic Approaches to Psychiatry

Published online by Cambridge University Press: 27 May 2021

Simon Heyland

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Rachel Gibbons and

Jo O'Reilly

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Summary

Since antiquity it has been postulated that emotions can produce or interact with physical illnesses. That statement in its broadest sense describes the field of psychosomatic medicine, which concerns itself with the multitude of ways that psychological and physical factors intersect – for example depression and myocardial infarction. The subject of this chapter is somewhat narrower – the issue of medically unexplained symptoms (MUS), defined below. A detailed account of the broader field of psychosomatics is given by Schoenberg [1].

Type: Chapter
Information: Seminars in the Psychotherapies , pp. 221 - 233

DOI: https://doi.org/10.1017/9781108686976.019 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

Schoenberg, P. Psychosomatics: The Uses of Psychotherapy. Basingstoke: Palgrave Macmillan, 2007.Google Scholar

Guthrie, E. Medically unexplained symptoms in primary care. Adv Psychiatr Treat 2008; 14: 432–40.Google Scholar

Hobson, AR, Furlong, PL, Sarkar, S et al. Neurophysiologic assessment of esophageal sensory processing in noncardiac chest pain. Gastroenterology 2006; 130: 80–8.Google Scholar

Perez, DL, Barsky, AJ, Vago, DR, Baslet, G, Silbersweig, DA. A neural circuit framework for somatosensory amplification in somatoform disorder. J Neuropsychiatry Clin Neurosci 2015; 27(1): e40–50.Google Scholar

Bornstein, R, Gold, S. Comorbidity of personality disorders and somatization disorder: a meta-analytic review J Psychopathol Behav Assess 2008; 30: 154–61.CrossRef Google Scholar

North, C. The classification of hysteria and related disorders: historical and phenomenological considerations. Behav Sci (Basel) 2015; 5(4): 496–517.CrossRef Google Scholar PubMed

Meares, R. A Dissociation Model of Borderline Personality Disorder. New York: W. W. Norton & Company, 2012.Google Scholar

Edwards, TM, Stern, A, Clarke, DD, Ivbijaro, G, Kasney, LM. The treatment of patients with medically unexplained symptoms in primary care. Ment Health Fam Med 2010; 7(4): 209–21.Google Scholar

Simon, GE, Von Korff, M. Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. Am J Psychiatry 1991; 148: 1494–500.Google Scholar PubMed

Khan, AA, Khan, A, Harezlak, J, Tu, W, Kroenke, K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics 2003; 44: 471–8.CrossRef Google Scholar PubMed

Nimnuan, C. Rabe-Hesketh, S, Wessely, S et al. How many functional somatic syndromes? J Psychosom Res 2001; 51(4): 549–57.Google Scholar

Creed, F, Henningsen, P, Fink, P. Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services. Cambridge: Cambridge University Press, 2011.Google Scholar

Fink, P. The use of hospitalisations by persistent somatising patients. Psychol Med 1992; 22: 173–80.CrossRef Google Scholar

Reid, S, Wessely, S, Crayford, T, Hotopf, M. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. BMJ 2001; 322(7289): 767–9.Google Scholar

Reid, S, Wessely, S, Crayford, T, Hotopf, M. Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. Br J Psychiatry 2002; 180: 248–53.Google Scholar

Bermingham, SL, Cohen, A, Hague, J, Parsonage, M. The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med 2010; 7: 71–84.Google Scholar

Chew-Graham, C, Heyland, S. Joint Commissioning Panel for Mental Health guidance for commissioners of services for people with MUS. London: JCP-MH, 2017.Google Scholar

Ringsberg, KC, Krantz, G. Coping with patients with medically unexplained symptoms: work-related strategies of physicians in primary health care. J Health Psychol 2006; 11(1): 107–16.Google Scholar

Dowrick, C, Gask, L, Hughes, JG et al. General practitioners’ views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study. BMC Fam Pract 2008; 19(9): 46.Google Scholar

Yon, K, Nettleton, S, Walters, K, Lamahewa, K, Buszewicz, M. Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study. BMJ Open 2015; 5: e009593.Google Scholar

Carson, AJ, Stone, J, Warlow, C, Sharpe, M. Patients whom neurologists find difficult to help. J Neurol Neurosurg Psychiatry 2004; 75: 1776–8.Google Scholar

Salmon, P, Peters, S, Clifford, R et al. Why do general practitioners decline training to improve management of medically unexplained symptoms? J Gen Intern Med 2007; 22(5): 565–71.Google Scholar

Ring, A, Dowrick, CF, Humphris, GM, Davies, J, Salmon, P. The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med 2005; 61(7): 1505–15.Google Scholar

Salmon, P, Humphris, GM, Ring, A, Davies, JC, Dowrick, CF. Primary care consultations about medically unexplained symptoms: patient presentations and doctor responses that influence the probability of somatic intervention. Psychosom Med 2007; 69: 571–7.Google Scholar

Winnicott, DW. Mind and its relation to the psyche-soma. In Winnicott, DW, Through Paediatrics to Psycho-Analysis. The International Psycho-Analytical Library, 100. London: The Hogarth Press and the Institute of Psycho-Analysis, 1975; pp. 243–54. (Original work published 1949)Google Scholar

Damasio, A. The Feeling of What Happens: Body, Emotion and the Making of Consciousness. San Diego: Harcourt Press, 2000.Google Scholar

Panksepp, J, Biven, L. The Archaeology of Mind: Neuroevolutionary Origins of Human Emotion. New York: W. W. Norton & Company, 2012.Google Scholar

Krystal, H. Desomatization and the consequences of infantile psychic trauma. Psychoanal Inq 1997; 17: 126–50.Google Scholar

Krueger, DW Integrating Body Self & Psychological Self: Creating a New Story in Psychoanalysis. New York: Taylor & Francis, 2002.Google Scholar

Adshead, G, Guthrie, E. The role of attachment in medically unexplained symptoms and long-term illness BJPsych Adv 2015; 21: 167–74.Google Scholar

Bass, C, Murphy, M. Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways. Journal Psychosom Res 1995; 39: 403–27.Google Scholar

Gottlieb, RM. Psychosomatic medicine: the divergent legacies of Freud and Janet. J Am Psychoanal Soc 2003; 51: 857–81.Google Scholar PubMed

Abbass, A, Kisely, S, Kroenke, K. Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009; 78: 265–74.Google Scholar

Taylor, GJ. Somatization and conversion: distinct or overlapping constructs? J Am Acad Psychoanal 2003; 31: 487–508.Google Scholar

National Institute for Health and Clinical Excellence. Irritable bowel syndrome in adults: diagnosis and management of IBS in primary care. London: NICE, 2008.Google Scholar

Guthrie, E, Creed, F, Dawson, D, Tomenson, B. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 1991; 100: 450–7.Google Scholar