Functional disorders and ‘medically unexplained physical symptoms’

Functional disorders (FDs) are characterized by physical symptoms that trigger the individual to seek healthcare but remain unexplained after appropriate medical assessment. They are common and cause significant distress and disability. What doctors say and do, and the design of the healthcare system, play key roles in their aetiology. When patients present with physical symptoms, it is important to rule out serious physical pathology. However, an early ‘positive’ diagnosis of FDs can lead to better outcomes than diagnosis by exclusion. Commonly associated psychiatric conditions include depression, anxiety and alcohol/substance abuse. If reassurance and simple reattribution techniques do not lead to symptom resolution, consider cognitive behavioural therapy or the use of antidepressants as neuromodulating agents (rather than as antidepressants per se).