Medically Unexplained Symptoms

What are Medically Unexplained Symptoms (MUS)...

Focusing on unconscious processes

Have you ever felt pain in your chest, only to have doctors tell you they can’t find any physical cause? Or perhaps you’ve experienced recurring headaches or migraines that don't respond to conventional medical treatments? These may be symptoms of underlying psychological issues that need to be addressed. Research has shown that one way to deal with such problems is through Intensive Short-Term Dynamic Psychotherapy (ISTDP).

A significant portion of emergency department visits, internal medicine visits, and medical specialist visits do not yield a medical explanation (i.e., a diagnosis that explains the root cause of the symptoms). People often leave their medical appointments with a diagnosis of “Chest pain”, or leave a primary care office with a diagnosis of “Fibromyalgia” or “Irritable Bowel Syndrome”, or what the medical profession has leballed a "Functional Disorder". These diagnoses describe the symptoms, but do not help us understand the cause or the best treatment for the symptoms. Often, treatments are recommended, such as changes in diet, exercise, or medications, and these may reduce the symptoms. However, if emotional factors are the true cause or are a major contributor to the symptoms, those treatments will have only limited effects. This can have a frustrating emotional impact on patients and doctors, which can actually lead to a worsening of symptoms.

Fortunately, ISTDP employs diagnostic and therapeutic techniques that are able to detect and treat emotional processes at the root of such problems. There is evidence that these methods lead to reduced healthcare costs and symptom improvement, even after a very brief treatment course of ISTDP.

In ISTDP, the therapist is a far more active agent of change. Your therapist will help you to feel emotions that may have become avoided without knowing. Your therapist will help you embrace this change as a means of recovery by directly helping confront any resistance to change you may exhibit.

Perhaps most importantly, ISTDP is driven by results. This treatment has been extensively researched and shown to be effective with a wide range of presenting problems that often co-occur for people suffering from medically unexplained physical symptoms that are driven by emotional factors.

The Melbourne Centre for ISTDP can provide:

  1. Differential Diagnosis: helping you determine whether emotional factors are contributing to your MUS
  2. Effective Treatment: helping you overcome the emotional factors that are contributing to your physical symptoms and any other emotional difficulties you would like to address
  3. Collaboration: working with your current medical providers to develop an optimal treatment plan based on our understanding of the role of emotional factors and physical factors in your symptoms

Costs Associated with Medically Unexplained Symptoms

  • Half of all GP medical visits are related to physical complaints, the causes of 30 - 50% of these physical problems are unable to be medically explained
  • Many are individual physical symptoms, such as pain (e.g., low back, joint, chest, abdominal, headache) and non-pain (e.g., fatigue, dizziness, palpitations) complaints.
  • Others consist of a cluster of physical symptoms for which the cause is poorly understood, such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, temporomandibular disorder and interstitial cystitis.
  • These physical complaints often overlap, with people experiencing a multitude of such physical problems or, finding one set of physical problems abating only to experience the onset of another set of physical problems that cause a similar level of impairment.
  • It is common for these physical problems to also be experienced by other family members.
  • Medications for these symptoms only have a small effect as they cannot address the causal issue and therefore, at best, can only partly reduce the symptoms.
  • Distressing physical symptoms are also increased 2- to 3-fold in people with depressive and anxiety disorders.
  • It has also been shown that the severity of many symptoms in people with medically explainable conditions are influenced as much by psychological factors as by the severity of the underlying medical condition. For example, in epilepsy it is estimated that up to 4 in 5 seizures are either caused by, or exacerbated by, psychological factors.
  • Research has found that patients with hypertension, migraine, irritable bowel syndrome and other conditions internalise emotions and this leads to increased physical problems.
  • How Do Medically Unexplained Symptoms Occur?

    When feelings are frightening, conflicted, or considered unacceptable, they generate anxiety and internal or behavioural mechanisms (defences) that act to cover this anxiety. This usually begins early in life when there are emotional difficulties in family dynamics/relationships. In these situations, children often have strong conflicting feelings towards other family members, but they are unable to understand and work through these feelings with the family members and so these feelings are often pushed out of awareness through anxiety and defences.

    Essentially, the child develops a pattern of turning feelings inward into physical symptoms and becomes prone to such complaints as abdominal pain, headache, depression, and a wide range of other physical problems. These patterns tend to persist and even “evolve” over time. This often results in the experience of chronic physical problems that are exacerbated in situations that trigger strong feelings - the person doesn’t get to physically experience their strong feelings, instead they get an increase in their physical symptoms.

    ISTDP Treatment for Medically Unexplained Symptoms

    The emphasis of ISTDP is to rapidly help the person to experience the repressed emotions that are leading to physical problems. The main interventions are to help and encourage the person to become aware of, and experience, their feelings and helping the person to block the old (unconscious) patterns of internalising their feelings.

    Below is a list of physical symptoms/conditions that, after a medical cause has been excluded, ISTDP has been shown to treat effectively:

          • Fibromyalgia
          • Headache
          • Muscle Spasm
          • Backache
          • Chest Pain
          • Shortness of Breath
          • Abdominal Pain
          • Chronic Fatigue Syndrome
          • Chronic Pain Syndrome
          • Irritable Bowel Syndrome
          • Nausea
          • Bladder Spasm
          • Bronchospasm
          • Coronary Artery Spasm
          • Hypertension
          • Migraine
          • Visual Blurring
          • Blindness
          • Mental Confusion
          • Memory Loss
          • Dizziness
          • Muscle Weakness
          • Pseudo-Seizures
          • Fainting
          • Paralysis
          • Loss of Voice