Medically unexplained physical symptoms

At a glance

  • Sometimes doctors can't find a medical explanation for persistent symptoms such as headaches, back pain, stomach and bowel problems, feeling faint or dizzy, or unusual sensations.
  • This doesn't mean the symptoms are "all in your head," though.
  • Medically unexplained physical symptoms (MUPS) often go away on their own after a few weeks.
  • But they can be very distressing if they last a long time.
  • Then it's important to talk to your doctor about possible explanations and things that might help.

Introduction

Photo of two women talking

Most of us have problems like diarrhea, headaches or dizziness from time to time. Although they can be unpleasant, they usually go away quickly. If symptoms persist, they often have a specific cause, like an or injury. But sometimes doctors don’t find a clear explanation. Then the symptoms are considered to be medically unexplained physical symptoms (MUPS). People with these symptoms are sometimes said to have a functional disorder, somatoform disorder, or somatic symptom disorder. Even though the doctor can't find a cause, it doesn’t mean the symptoms are all in your head or you can’t do anything about them.

Having symptoms for no known reason can be unsettling – but they can often be relieved or even go away on their own within a few weeks. The main thing to do at first is stay active in daily life and find ways to manage the symptoms.

If the unexplained symptoms last a long time, it can become very frustrating and distressing. Then it's sometimes a good idea to get other help too, such as psychological support. Over the long term, medications help very little – if at all.

This information is mainly about adults. Some causes, symptoms and treatments are different in children.

Symptoms

Common medically unexplained physical symptoms include:

  • Pain, especially in the head, belly, back and muscles
  • Stomach and bowel problems like nausea, vomiting, bloating, diarrhea and constipation
  • Drowsiness, heart palpitations and chest tightness
  • Exhaustion, tiredness and concentration problems
  • Dizziness
  • Difficulty breathing and panic-like attacks, where your breathing gets much faster and deeper (hyperventilation)
  • Muscle tension and cramping
  • Abnormal sensations like itching, tingling and numbness
  • Bladder problems like a strong urge to pee and pain when peeing

These symptoms may be accompanied by anxiety and depressed moods. Some people also have a strong feeling that there's something in their body that shouldn't be there, or they regularly feel areas on their body that seem abnormal to them.

Fibromyalgia or irritable bowel syndrome (IBS) can also cause symptoms that are distressing but difficult to explain at first. So these conditions are similar to functional disorders in many ways.

Causes

The fact that no physical cause has been found doesn’t mean that there are no reasons for the symptoms. In many cases, physical and psychological factors probably come together – for example, feeling overwhelmed, previous medical problems, your genes, difficult life circumstances, or conflicts with other people.

The perceived intensity of the symptoms varies, as does the way people cope with them. For some, the symptoms are very bad and greatly affect their daily life, while others don't pay much attention to them. Another thing that plays a role is how you manage stress.

What's more, it’s possible for an organ to be healthy but still not work ("function") properly. That is why these symptoms are often called "functional" symptoms. One example is the bowel: You can have digestion problems in the bowel without having any injuries, inflammations or diseases like growths there. Bowel function can be affected by other things – like stress, for example. Stress can lead to diarrhea, bloating or constipation.

Prevalence

It is estimated that about 10% of the population have symptoms that can’t be clearly explained. Unexplained symptoms are twice as common in women as in men. There may be biological reasons for this: How pain is experienced can depend on , for example. Societal and cultural factors probably play a role here, too – for example, different role expectations and life experiences. Plus, women are more likely to seek medical help than men are.

Effects

Functional disorders are usually harmless. They are often mild and temporary, but can sometimes be very distressing and last a long time. They can cause both physical problems and mental health problems. These can make it harder to manage in your daily family and working life, and sometimes impossible to keep your current job.

Many people find it difficult to stay active when they have these persistent complaints, or they feel like they need to rest. This can become a vicious cycle because rest often makes certain problems (like muscle and joint pain) worse.

Persistent symptoms can cause stress and greatly affect your mental health. About half of all people who have unexplained physical symptoms also develop symptoms of depression or an anxiety disorder. Others manage to stay relaxed despite their unexplained symptoms. That is often easier if you notice that the symptoms are sometimes better and sometimes worse. It can also be easier to cope with the symptoms if you stay optimistic and trust that they will get better at some point.

Many people who have unexplained symptoms go to the doctor a lot and often switch doctors. This may be because they think their doctor isn't taking them seriously so they feel very alone with their problem. Or they think that the doctor hasn't done enough tests. Different doctors often have very different explanations for functional symptoms.

Functional disorders can greatly affect your quality of life. But they usually don’t affect your life expectancy: On average, people with unexplained physical symptoms live as long as others do.

Diagnosis

When you go to the doctor, they will talk to you at first. Then they will do a physical examination to get a better idea of the symptoms. They may take a blood sample or do an ultrasound scan. After that, the doctor can often already say if a clear cause is likely to be found and whether treatment is needed. Doctors first consider medical conditions that commonly cause the symptoms. They also look for signs of serious illnesses.

Sometimes they might arrange for you to have further examinations or refer you to a specialist. This will depend on how bad the symptoms are and how they change over time. Although a wide range of examinations can be done, doctors typically wait at first because functional symptoms often improve on their own after a few weeks. Further examinations may be considered if distressing symptoms last for a longer time or get worse. Physical causes or medical conditions are only rarely found later.

Important

Even if further examinations or tests could be done, it's not always a good idea to do them. Some are associated with health risks.

The more examinations you have, the higher the risk of "false positive" results – where the results suggest that you have a certain medical problem but that actually isn't true. These findings can be worrying and needlessly lead to more examinations.

If the symptoms last, it’s important to keep going to your doctor. Even if no clear cause can be found, you can talk to them about

  • what might be causing the symptoms or making them worse and
  • what can help to relieve them and cope better with them.

These ideas can then be reviewed and modified at the next visit, if needed. The best approach is usually to look for explanations and suitable measures together with your doctor.

Illustration: Checklist to prepare for your doctor's appointment

Go to the checklist

If distressing symptoms last for a long time, it can be a good idea to get support from a psychotherapist or specialist in psychosomatic medicine. Psychosomatic facilities usually specialize in the treatment of functional disorders.

Treatment

The symptoms often get better within a few weeks even without treatment. That’s why doctors hold back on treatment at first. If the symptoms are mild, they often only give advice on how to cope with them in daily life.

For example, they may advise you to

  • be physically active,
  • stay involved in the community, meet up with friends, and continue doing your hobbies,
  • recognize when things get too much for you, reduce stress factors in your life if possible, resolve conflicts, and rethink how you manage stress,
  • observe what helps to relieve symptoms,
  • have a healthy lifestyle, and get enough sleep.

Medications may be considered in certain situations, too. For example, they can be used for the treatment of pain or gastrointestinal (stomach and bowel) symptoms – but usually only for a short time.

Sometimes, symptoms last for a long time or affect several organs and become very distressing. Then psychological support might help. In some situations, other approaches are used too – including things like physical therapy, dietary advice and occupational therapy. You can also try relaxation techniques or mindfulness training to help you cope better with stress.

As a general rule, being active yourself is more helpful than focusing on “passive” measures like massages, for example. If at all, passive approaches are only recommended as temporary measures in addition to other approaches. It is better to find activities that have a more lasting effect. These may include more exercise and stress management techniques, for example. Although this might involve more effort and patience at first, many people soon get used to it and feel better as a result. Exercise shouldn’t be too strenuous. Instead, it should mainly be enjoyable and a positive experience.

Patience is typically needed, especially with persistent and distressing symptoms. Because of this, it’s often better to set yourself small goals. It can be helpful to focus on leading an active life despite the symptoms – by staying active, distracting yourself, and only expecting the symptoms to improve a little at first.

When seeking treatment for functional symptoms, people usually first go to see their family doctor. Many family doctors have extra training in psychosomatic medicine and are specialized in helping patients who have persistent symptoms. If necessary, they coordinate treatment with specialists in practices or hospitals.

Rehabilitation

Only few people with functional disorders need rehabilitation treatment. It can be considered, for example, if someone is no longer able to work. Rehabilitation can then help them get ready to start working again. Other goals of rehabilitation may include preventing the progression of symptoms, remaining socially active, and continuing to work. Depending on your situation, rehabilitation treatment can have different areas of focus. Rehabilitation treatment always includes both physical and psychological approaches.

Depending on the type and severity of the health problems, outpatient or inpatient treatment may be recommended. In Germany, medical rehabilitation is usually covered by the German pension insurance. In some cases, though, it’s covered by your statutory health insurance or statutory accident insurance.

Further information

People who have unexplained physical symptoms often use many different sources of information, including the internet. It is important to be skeptical here and check the quality of information on the internet. You're more likely to fall for scams and false promises if you're unhappy with your doctors. Checklists can help you to assess the information you find.

You can contact support groups and information centers, too. The website of the German Association of Psychotherapists has a search function for psychotherapists in Germany. The appointment-finding service of the Association of Statutory Health Insurance Physicians can help you get an appointment at a practice in Germany.

The German National Alliance for Chronic Rare Diseases (ACHSE) provides information on rare diseases.

Deutsches Kollegium für Psychosomatische Medizin (DKPM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM). Funktionelle Körperbeschwerden (S3-Leitlinie). AWMF-Registernr.: 051-001. 2018.

Deutsches Kollegium für Psychosomatische Medizin (DKPM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Deutsche Arbeitsgemeinschaft Selbsthilfegruppen et al. Patientenleitlinie (S3) „Funktionelle Körperbeschwerden“: Funktionelle Körperbeschwerden verstehen und bewältigen. Eine Leitlinie für Betroffene und ihre Angehörigen. AWMF-Registernr.: 051-001. 2018.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on March 14, 2023

Next planned update: 2026

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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