6 General adult psychiatry6.3 Liaison psychiatry
6.3.4 Persistent physical symptoms
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What the terms mean
Medically unexplained symptoms are physical symptoms with no sufficient explanation after an appropriate assessment. This is not a single diagnosis, and it does not prove a psychological cause.
Persistent physical symptoms is often a more useful term. Even without structural disease, the mechanisms can often be partly understood.
The symptoms are real and can cause substantial disability. If no test result explains them, that does not mean the person is making them up.
Assessment
Area | What to find out |
|---|---|
Symptoms | Onset, pattern, triggers, associated features and previous investigations |
Function | Activity, sleep, work, relationships and what the person avoids |
Physical health | Examination, warning signs, other illnesses and medication side effects |
Psychological state | Mood, anxiety, trauma where relevant, beliefs about the illness and coping |
Care history | Previous explanations, treatments that helped or harmed, and repeated referrals |
New or changing warning signs need proper reassessment. A previous functional diagnosis does not stop physical disease developing later.
Functional neurological disorder is diagnosed on positive clinical features of altered function, not on normal investigations alone.
Somatic symptom and bodily distress diagnoses rest on positive psychological or behavioural features, not just on symptoms being unexplained.
Building a shared explanation
Start by acknowledging the symptom and its effect on the person's life. Then discuss possible mechanisms.
Things that can keep symptoms going include:
disturbed sleep
more attention to bodily sensations
autonomic arousal (the body's stress response, such as a racing heart)
avoidance
deconditioning (loss of fitness from inactivity)
repeated reassurance-seeking.
An individual formulation tests which of these apply to this person. Do not assume that stress explains every symptom.
Be clear about uncertainty: say what has been ruled out and what would prompt further investigation.
Management
Continuity of care. A named clinician and planned reviews reduce conflicting advice and repeated, uncoordinated investigations.
Broad goals. Target function, sleep, distress and meaningful activity, as well as symptom relief.
Psychological therapies help the person cope and break the cycles that keep symptoms going. They do not imply the symptoms are imagined.
Physical rehabilitation should fit the actual condition and what the person can tolerate. Do not impose one generic activity plan across different syndromes.
Other illnesses such as depression, anxiety or pain need their own evidence-based treatment.
Reviews check progress, treatment harms and new clinical findings. They do not close the diagnostic question for good.