Medically Unexplained Symptoms (MUS): What Do Current Trainee Psychologists, Neurologists and Psychiatrists Believe?


Objectives: Medically unexplained symptoms (MUS) are common in all medical settings. These conditions remain controversial, aetiology remains poorly understood and treatments have been slow to develop. This study aimed to examine the beliefs held by psychologists and other professionals about MUS, which may impact upon clinical practice. Design: 375 clinical psychology trainees from 23UKtraining courses, 12 neurologists and 19 psychiatrists in training completed a weblink survey designed to elicit a range of beliefs about MUS cause and treatment. Results: All three groups viewed MUS as a common clinical problem. Use of terminology differed between groups. All three groups held a view that sexual abuse was a medium to high risk factor for developing MUS. Only a minority of psychologists and psychiatrists doubted that the human mind is capable of massive repression for past distressing events; and few psychologists, and no psychiatrists, doubted the traditional psychodynamic causal model of MUS. Neurologists were generally more skeptical. Only a minority of all three groups disagreed that hypnosis was a helpful way to uncover memories that people can not access. Around one third of each group believed that traumatic memories recovered in therapy were reliable. Dualistic thinking was prevalent among all three groups, but more so among psychiatrists. Conclusions: The data show that many professsionals hold beliefs about MUS for which, empirical support is lacking. These beliefs may impact on clinical practice. Whether such beliefs are deemed to be correct or incorrect, they should be acknowledged.

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S. Kemp, C. Spilling, C. Hughes and K. Pauw, "Medically Unexplained Symptoms (MUS): What Do Current Trainee Psychologists, Neurologists and Psychiatrists Believe?," Open Journal of Medical Psychology, Vol. 2 No. 1, 2013, pp. 12-20. doi: 10.4236/ojmp.2013.21003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. Reid, S. Wessely, T. Crayford and M. Hotopf, “Frequent Attenders with Medically Unexplained Symptoms: Service Use and Costs in Secondary Care,” The British Journal of Psychiatry, Vol. 180, 2002, pp. 248-253. doi:10.1192/bjp.180.3.248
[2] A. J. Carson, B. Ringbauer, J. Stone, L. McKenzie, C. Warlow and M. Sharpe, “Do Medically Unexplained Symptoms Matter? A Prospective Cohort Study of 300 New Referrals to Neurology Outpatient Clinics,” Journal of neurology, neurosurgery and psychiatry, Vol. 68, No. 2, 2000, pp. 207-210. doi:10.1136/jnnp.68.2.207
[3] A. M. Parry, B. Murray, Y. Hart and C. Bass, “Audit of Resource Use in Patients with Non-Organic Disorders Admitted to a UK Neurology Unit,” Journal of neurology, neurosurgery and psychiatry, Vol. 77, No. 10, 2006 , pp. 1200-1201. doi:10.1136/jnnp.2006.089888
[4] F. Mari, C. Bonaventura and N. Vanacore, et al., “Video-EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy,” Epilepsia, Vol. 47, No. S5, 2006, pp. 64-67. doi:10.1111/j.1528-1167.2006.00880.x
[5] P. Ribai, P. Tugendhaft and B. Legros, “Usefulness of prolonged Video-EEG Monitoring and Provocative Procedures with Saline Injection for the Diagnosis of Nonepileptic Seizures of Psychogenic Origin,” Journal of Neurology, Vol. 253, No. 3, 2006, pp. 328-332. doi:10.1007/s00415-005-0991-9
[6] J. Kuyk, F. Leijten, H. Meinardi, P. H. Spinhoven and R. Van Dyck, “The Diagnosis of Psychogenic Non-Epileptic Seizures,” Seizure, Vol. 6, No. 4, 1996, pp. 243-253. doi:10.1016/S1059-1311(97)80072-6
[7] O. Devinsky, F. Sanchez-Villase?or, B. Vazquez, M. Kothari, K. Alper and D. Luciano, “Clinical Profile of Patients with Epileptic and Nonepileptic Seizures,” Neurology, Vol. 46, No. 6, 1996, pp. 1530-1533. doi:10.1212/WNL.46.6.1530
[8] O. Devinsky and E. Gordon, “Epileptic Seizures Progressing Into Nonepileptic Conversion Seizures,” Neurology, Vol. 51, No. 5, 1998, pp. 1293-1296. doi:10.1212/WNL.51.5.1293
[9] A. J. Carson, R. Brown, A. S. David, R. Duncan and M. J. Edwards, et al., “Functional (Conversion) Neurological Symptoms: Research since the Millennium,” Journal of Neurologyogy, Neurosurgery and Psychiatry, Vol. 83, No. 8, 2012, pp. 842-850. doi:10.1136/jnnp-2011-301860
[10] S. Wessely and P. D. White, “There Is Only One Functional Somatic Syndrome,” The British Journal of Psychiatry, Vol. 185, 2004, pp. 95-96. doi:10.1192/bjp.185.2.95
[11] R. A. Kanaan, D. Armstrong and S. C. Wessely, “Neurologists’ Understanding and Management of Conversion Disorder,” Journal of neurology, neurosurgery and psychiatry, Vol. 82, No. 9, 2011, pp. 961-966. doi:10.1136/jnnp.2010.233114
[12] T. R. J. Nicholson, J. Stone and R. A. A. Kanaan, “Conversion Disorder: A Problematic Diagnosis,” Journal of neurology, neurosurgery and psychiatry. Vol. 82, No. 11, 2012, pp. 1267-1273. doi:10.1136/jnnp.2008.171306
[13] H. Ellenberger, “The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry,” Basic Books, New York, 1970.
[14] J. Pintar and S. J. Lynn, “Hypnosis: A Brief History,” Wiley-Blackwell, Hoboken, 2008.
[15] E. F. Loftus, “Planting Misinformation in the Human Mind: A 30-Year Investigation of the Malleability of Memory,” Learning Memory, Vol. 12, No. 4, 2005, pp. 361-366. doi:10.1101/lm.94705
[16] R. J. McNally, “Troubles in Traumatology,” The Canadian Journal of Psychiatry, Vol. 50, No. 13, 2005, pp. 815-816.
[17] R. J. McNally, “Debunking Myths about Trauma and Memory,” The Canadian Journal of Psychiatry, Vol. 50, No. 13, 2005, pp. 817-822.
[18] R. J. McNally, “A New Solution to the Recovered Memory Debate,” Perspectives on Psychological Science, Vol. 4, No. 2, 2009, pp. 126-134. doi:10.1111/j.1745-6924.2009.01112.x
[19] IAPT, “Medically Unexplained Symptoms: Positive Pra-Ctice Guide,” IAPT, London, 2008.
[20] Department of Health, “Talking Therapies: A Four-Year Plan of Action,” Department of Health, London, 2011.
[21] A. Demertzi, C. Liew, D. Ledoux, M.-A. Bruno and M. Sharpe, et al., “Dualism Persists in the Science of Mind,” Disorders of consciousness, Vol. 1157, 2009, pp. 1-9.
[22] J. Fahrenbergand M. Cheetham, “The Mind-Body Problem as Seen by Students of Different Disciplines,” Journal of Consciousness Studies, Vol. 7, No. 5, 2000, pp. 47-59.
[23] D. Dennett, “The Intentional Stance,” MIT Press, Cambridge, 1997.
[24] P. White, “Biopsychosocial Medicine,” Oxford University Press, Oxford, 2005.
[25] H. Leventhal, D. Nerenz and D. J. Steele, “Illness Representations and Coping with Health Threats,” In: A. Baum, S. E. Taylor and J. E. Singer, Eds., Handbook of psychology and Health, Erlbaum, Hillsdale, 1984, pp. 219-252.
[26] R. Whittaker, S. Kemp and A. House, “Illness Perceptions and Outcome in Mild Head Injury: A Longitudinal Study,” Journal of neurology, neurosurgery and psychiatry, Vol. 78 No. 6, 2007, pp. 644-646. doi:10.1136/jnnp.2006.101105
[27] S. Kemp, S. Morley and E. Anderson, “Coping with Epilepsy: Do Illness Representations Play a Role?” British Journal of Clinical Psychology, Vol. 38, No. 1, 1999, pp. 43-58. doi:10.1348/014466599162656
[28] J. Van Gijn and B. Bonke, “Interpretation of Plantar Reflexes,” Journal of Neurology, Neurosurgery and Psychiatry, Vol. 40, No. 8, 1977, pp. 787-789. doi:10.1136/jnnp.40.8.787
[29] P. Salmon, S. M. Al-Marzooqi, G. Baker and J. Reilly, “Childhood Family Dysfunction and Associated Abuse in Patients with Nonepileptic Seizures: Towards a Causal Model,” Psychosomatic Medicine, Vol. 65, No. 4, 2003, pp. 695-700. doi:10.1097/01.PSY.0000075976.20244.D8
[30] A. Vickers, N. Goyal, R. Harland and R. Rees, “Do Certain Countries Produce Only Positive Results?” Controlled Clinical Trials, Vol. 19, No. 2, 1998, pp. 159-166. doi:10.1016/S0197-2456(97)00150-5
[31] J. L. Jackson and K. Kroenke, “Difficult Patient Encounters in the Ambulatory Clinical: Clinical Predictors and Outcomes,” Archives of Internal Medicine, Vol. 159, No. 10, 1999, pp. 1069-1075. doi:10.1001/archinte.159.10.1069

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