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Medically Unexplained Physical Symptoms


MUPS are defines as complaints of physical symptoms or signs for ... The diversity of conditions that fall under this classification ... Factitious ... – PowerPoint PPT presentation

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Title: Medically Unexplained Physical Symptoms

Medically Unexplained Physical Symptoms
  • MUPS are defines as complaints of physical
    symptoms or signs for which there is no adequate
    objective pathophysiologic evidence to explain
    the distress. The diversity of conditions that
    fall under this classification remains a source
    of controversy and paradox.

  • MUPS are encountered principally in medical
    settings, where patients and clinicians often are
    unfamiliar with psychological explanations.

  • MUPS implies the presence of symptoms that do not
    conform to known disease processes. MUPS defines
    a predicament rather than a disorder, a way of
    drawing attention to a societal situation in
    which the meaning of distress is contested. It
    is critical to accept that unexplained does not
    necessarily imply purely psychological origins,
    as the history of psychiatry is replete with
    examples of disorders once considered
    functional, that were subsequently proven to
    result from organic processes.

  • Some patients may have vague symptoms initially
    that appear to be unexplained, only to manifest
    clearer evidence of underlying disease later in
    the course of illness (i.e. multiple sclerosis or
    myasthenia gravis).

  • Is it normal for patients to occasionally seek
    reassurance for transient physical symptoms? What
    is the threshold for distinguishing MUPS from
    worried-wellness, and should it depend on
    symptoms, severity, chronicity, or functional
    impairment? Is the degree of conscious awareness
    versus volitional control of reliable factor in
    distinguishing MUPS disorders?

  • Sharpe and Mayou questioned the validity of MUPS
    as a defining feature of somatoform disorders and
    challenged the assumption of psychogenesis in
    many of these disorders. Ballas and Staab also
    questioned contemporary criteria and suggested
    classifying MUPS based on organ systems.

  • The direct and indirect economic costs
    attributable to MUPS are staggering. Patients
    with MUPS have increased healthcare utilization
    rates, including frequent visits, demands for
    tests, unnecessary surgery, numerous
    consultations, and hospitalizations.

  • The current financial cost of MUPS in the United
    States exceeds 100 billion annually. This does
    not include substantial indirect costs of lost
    workplace productivity and disability payments.
    Another burden and hidden cost to society stems
    from prescription and over-the-counter drug sales
    targeting common minor ailments and fueled by
    direct-to-consumer advertising.

Secondary MUPS Syndromes
  • Secondary MUPS syndromes encompass patients with
    primary psychiatric disorders. A variety of
    nonspecific physical complaints often are
    associated. Up to 76 of patients hospitalized
    for depression report multiple pain symptoms.
    Vegetative symptoms form an integral part of
    diagnostic criteria for depression, ruminate
    about fatigue, weight loss, pain, somatic
    depression or masked depression, these
    physical ailments occur frequently in depression,
    especially among the elderly.

  • MUPS are common among patients with anxiety
    disorders and compromise a significant component
    of diagnostic criteria through activation of the
    autonomic nervous system and comes to clinical
    attention because of palpitations, chest pain,
    dizziness, abdominal discomfort, and other

  • Patients with psychotic disorders
    schizophrenia, mood disorders, substance induced
    psychosis, delusional disorder, delirium, or
    dementia also may present with MUPS.

  • Delusional Disorder Somatic Type
  • Somatization Disorder
  • Conversion Disorder
  • Hypochondriasis
  • Body Dysmorphic Disorder
  • Pain Disorder
  • Factitious Disorders
  • Malingering

  • Early psychodynamic hypotheses were based on
    studies of hysteria. Central to this line of
    reasoning is the notion of conversion as
    reflecting defense mechanisms that symbolically
    transform unconscious emotional trauma and
    conflict into physical symptoms.

  • More recent work in mental cognitive
    neuropsychology extends and clarifies
    psychodynamic mechanisms underlying MUPS. New
    ideas concern the development of emotional
    processing from nonverbal, subsymbolic expression
    in childhood to more mature, adaptive and verbal
    abilities that allow for translation of emotional
    states into identifiable feelings on an abstract,
    logical and reality-based level.

  • MUPS are the result of activation of or
    regression to subsymbolic somatic symptoms
    disassociated from verbal, symbolic
    representations of feelings and objects. Patients
    therefore experience somatic signs only, detached
    from psychological meaning or in other words,
    they exhibit alexithymia.

  • MUPS are associated somatoform disorders remain
    an enormous problem in terms of prevalence,
    personal suffering and disability, and costs to

  • In the culture of the modern era, characterized
    by increasing social, political, and economic
    pressures to label syndromes with or without
    scientific support, to promote quick and
    profitable remedies, and to control costs all at
    the same time, the need for better understanding
    of MUPS has never been more compelling.