Medically Unexplained Physical Symptoms - Contested Causation

Contested Causation

The lack of known etiology in MUPS cases can lead to conflict between patient and health-care provider over the diagnosis and treatment of MUPS. This conflict can occur in the public arena and may involve media controversy, advocacy groups, scientific and political debate and even legal proceedings.

Diagnosis of MUPS is seldom a satisfactory situation for the patient, as many patients feel this implies it is "all in their head." This can lead to an adversarial doctor-patient relationship, which can develop into an iatrogenic neurosis, thus complicating the situation. A 2008 review in the British Medical Journal stated that a doctor must be careful not to tell a patient that nothing is wrong, "as clearly this is not the case." The symptoms that brought the patient to the doctor are real, even when the cause is not known. The doctor should try to explain the symptoms, avoid blaming the patient for them, and work with the patient to develop a symptom management plan.

According to psychiatrist Simon Wessely, "Various names have been given to medically unexplained symptoms. These include somatisation, somatoform disorders and functional somatic symptoms." He writes that "a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences." In reply, the psychiatrist Peter White has stated that "the concept of a general functional somatic syndrome is unhelpful in understanding illness, aetiology, treatment and outcome". In another publication, Wessely states that providing a label for a set of symptoms "is not a neutral act, since specific labels are associated with specific beliefs and attitudes," and "even when organic illness is certain, the illness label can result in adverse behaviour changes.", while there is conflicting evidence on whether such labelling is helpful.

Luxembourg et al. write that a substantial portion of MUPS and associated somatoform disorders have a clearly-identified cause: repeated psychological traumas, particularly during childhood. Evidence indicates that repeated abuse or other traumas often leads to disturbed lymphatic system functioning, under-production of cortisol and overproduction of endogenous opioids, all of which can contribute to MUPS. Those who were seriously traumatized on three or more occasions during childhood were substantially more likely than a control group to develop such difficult-to-treat MUPS as chronic headaches, pelvic pain, and seizures. Trauma researcher Bessel van der Kolk has noted that chronically abused persons sometimes report a baffling array of MUPS while simultaneously reporting none of the expected psychological distress related to their abuse; he further suggests that, due to severe dissociation, chronic physical symptoms are these people's only means of expressing what would otherwise be overwhelming emotional pain.