The Psychology of Unexplained Physical Symptoms


By Stephen M. Pfeiffer, Ph.D.

Have you ever visited a doctor with a symptom, such as a headache, abdominal pain or back pain, only to be told that he or she can’t find anything wrong with you? This is actually quite common, and a well known fact in the health care provider community. A recent article in the

Wall Street Journal

by Andrea Peterson, cites a 2011 German study that unexplained symptoms made up two-thirds of all reported symptoms. Peterson also cited a study that showed that 10 percent to 20 percent of US primary-care patients have unexplained symptoms that impair them somehow.

Peterson makes it clear that these occurrences are not cases of what was previously known as hypochondriasis (now known as illness anxiety disorder) in which the physical symptoms may be nonexistent yet the patients are afraid of having a serious disease. However, what her article discusses is that these patients with continuing unexplained symptoms might have an underlying psychiatric disorder.

According to Robert C. Smith

, professor of medicine and psychiatry at the Michigan State University College of Human Medicine, underlying psychological issues might be fueling the symptoms and the “health-seeking” behavior. As a result, Dr. Smith and his colleagues have developed a treatment for primary-care providers to deliver to patients who repeatedly return to them with unexplained symptoms. The treatment combines antidepressant medication and the elimination of narcotic pain drugs with relaxation techniques and exercise.

Cognitive behavioral treatment (CBT) has proven to be extremely effective. The article includes a study published last year, which adds to the extensive literature on CBT, that found that the cognitive behavioral therapy program and a relaxation training program reduced symptoms, improved mental health and reduced impairment in patients who frequently visited their primary-care doctors. Patients also visited their doctors fewer times. CBT can be provided to patients in as little as four to eight sessions. The patients are taught to change their misconceptions about health and symptoms. They are also encouraged to stop obsessively researching their symptoms online, taught how to distract themselves from their symptoms, and given relaxation and mediation techniques.

Peterson shares the success story of a 17-year-old who all of a sudden began to experience unexplained symptoms of nausea, headaches and vertigo that lasted for months and hampered her ability to study and communicate. By going through the weekly therapy sessions, which taught her to keep a symptom diary and accept her emotions, she is now fully functional.

Many don’t realize how interconnected the mind and body are and how common it is for psychological issues to manifest as physical discomfort. If you are experiencing chronic, unexplained physical symptoms, please feel free to reach out to me at or at my website,