Many people suffer from persistent complaints, such as dizziness or pain, that do not appear to have an obvious cause.

They are termed “medically unexplained symptoms” when doctors cannot find any disease or problem with the body that would otherwise account for the symptoms.

This doesn’t mean the symptoms are faked or are “all in the head” – they are real and can affect your ability to function properly. Not understanding the cause can make them all the more distressing and difficult to cope with.

Such mystery symptoms are surprisingly common, accounting for a fifth of all GP consultations in the UK. 

Why do they happen?

Many people suffering from medically unexplained symptoms such as fatigue, pain and heart palpitations will also have depression or anxiety disorders. For these people, treating the psychological problem can often relieve the physical symptoms.

For others, the symptoms may be part of a poorly understood syndrome like chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS) or fibromyalgia. A psychological or lifestyle problem may play a role in these cases as well – for example, IBS symptoms can be brought on by stress in some people and managing the stress can help relieve the symptoms. However, there may be other triggers, too (for example, IBS and CFS can occur after infections).

Sometimes, there is simply no explanation and doctors cannot diagnose a cause. This is not unusual in medicine and doesn’t mean that nothing can be done to help you (see ‘How can my GP help?’ below).  

If you are worried you have an underlying disease that has been missed by your doctor, you can ask for a second opinion.

What sort of complaints can be ‘unexplained’?

Medically unexplained symptoms tend to be quite general problems, such as:

• fatigue 
• pain
• heart palpitations 
• dizziness and nausea

These are often experienced alongside depression and/or anxiety (see ‘What’s the connection between mental and physical health?’ below).

The symptoms affect every person differently – some will see their GP regularly with relatively minor symptoms, while others may become disabled by them.

Who is more likely to have them?

Unexplained symptoms are reported to be more common among:

• women
• younger people (symptoms often start before the age of 30)
• those who have recently had an infection or physical illness, or those affected by the ill health or death of a relative
• those who have previously experienced problems such as depression 

However, it’s worth bearing in mind that women are more likely than men to see their GP with symptoms, and that some older people don’t like to bother their GP. 

What’s the connection between physical and mental health?

Just as poor physical health can lead to unhappiness and psychological problems, the opposite is also true.

Conditions such as low back pain, irritable bowel syndrome and eczema are known to be triggered or made worse by psychological problems such as stress, anxiety or depression.

This can lead to a vicious circle – for example, the emotional upset from being in constant physical pain can lead to depression, the depression then worsens the pain and may trigger other symptoms too.

How can my GP help? 

Your GP will first aim to rule out all the possible serious causes of your symptoms. You will probably have a thorough physical examination and blood tests.

It’s important to consider whether the cause of your symptoms may be any medication you are taking.

Your GP should also investigate whether you might have a problem such as depression or anxiety that may be causing or worsening your symptoms.

You should tell them:

• what the symptoms are like, when they started and what makes them better or worse
• what you think is the cause of your symptoms and your expectations of tests and treatments
• how the symptoms affect what you can do 
• how upsetting the symptoms are

There are then a number of things you can do that may help.

You and your GP may need to draw up a personal health plan – this means agreeing some lifestyle changes and goals that you both think will help your symptoms.

You may be referred for a talking therapy such as cognitive behavioural therapy (CBT). CBT aims to help you manage your symptoms by enabling you to understand links between your symptoms, worries, feelings and behaviour.

Medication such as antidepressants may be helpful. However, drugs are not always the answer – painkillers or sedatives, for example, may lead to dependance. The possible benefits of medication always need to be weighed against the potential side effects.

If you feel your GP isn’t taking your complaint seriously, you can get a second opinion.

What can I do myself to improve my symptoms? 

There are things you can do yourself, such as regular exercise and stress management, that can improve or even relieve some physical symptoms.

Regular exercise – say, three 20-minute sessions a week – will at least keep you fit and give you a chance to take a break from other tasks, or just to get out of the house. Many people find it also boosts their mood (read about exercise for depression). The exact amount of exercise or activity needs to match your current health and capabilities.

Managing stress is very important, as this has been linked to problems such as pain and irritable bowel syndrome. Learn some relaxation tips to relieve stress.

Generally, it should help to plan some pleasurable personal time to unwind – whatever helps you relax, whether it’s yoga classes, meditation or walks in the countryside. Read five steps to mental wellbeing.

Your body has a remarkable ability to recover and there’s a good chance your symptoms will get better in time, even without any specific treatment.