Unexplained physical symptoms

Symptoms that tests don’t fully explain are among the most common reasons people see a doctor. Different studies count in different ways, so numbers vary.

How common

Who & when

Getting better

Sometimes people have physical symptoms, like pain, tiredness or dizziness, and tests don’t find a clear physical illness to explain them. Doctors sometimes call these “medically unexplained” or “functional” symptoms.

They are very common. About 1 in 4 people who see their family doctor have symptoms like this. They are real, they can be very disabling, and they are not imagined.

There is rarely one single cause. Doctors often describe a mix of biological, psychological and social factors, the same as for many other illnesses.

Some people have physical symptoms, such as pain, tiredness or shortness of breath, that cause a great deal of distress. The worry, time and energy spent on the symptoms start to take over daily life. Professionals call this somatic symptom disorder (“soma” means body).

The symptoms may or may not have a known medical cause. Either way, they are real. The brain may simply be more sensitive than usual to body sensations and how it reacts to them. It is not “all in your head”.

It can look like

• Constantly worrying that symptoms mean something serious
• Feeling anxious or low about your health
• Finding it hard to do everyday things because of the symptoms and worry
• Not feeling reassured, even when tests come back normal
• Seeing many doctors for more tests
• Spending a lot of time and energy on health concerns

It can affect children, teens and adults, and usually begins by age 30. Without support, it tends to last a long time, coming and going over months or years, and can make work, home life and wellbeing harder.

The good news: the goal of treatment is learning to cope with symptoms and get back to life, and that is very possible. Cleveland Clinic advises getting help as soon as you start to feel overwhelmed.

Health anxiety is when you spend so much time worrying that you are ill, or will become ill, that it takes over your life. A tricky part is that anxiety itself causes headaches and a racing heart, which can be mistaken for signs of illness.

One of the hardest parts of living with symptoms that don’t show on tests is not being believed. Many people say they have felt dismissed or blamed, or been told their symptoms are “made up”.

Some people have “fallen through the gaps” because some health workers have had little training in these symptoms. Attitudes are improving, and kind, clear language helps people feel safe to get the care they need.

If you don’t feel believed

• Ask for an explanation of what the doctor thinks is going on
• Ask whether a specialist with experience in your symptoms can see you
• Bring a trusted person to appointments for support
• Remember: your symptoms are real, whatever the test results say
• Share reliable information, like this guide, with family and friends

Having one trusted primary care provider who knows your story can make a big difference, especially alongside a mental health professional. It can reduce the stress of retelling everything to new people and lead to more joined-up care.

Before and during an appointment

1. Write down your main symptoms, when they started and what makes them better or worse
2. Note how they affect your daily life: work, school, sleep, family
3. Bring a list of questions, and put the most important first
4. Ask: “What do you think is causing this?” and “What can I do to help myself?”
5. Ask which tests are really needed, and what the results would change
6. Ask about a plan: who to contact, and when to come back

Your doctor may suggest seeing a psychologist or psychiatrist with experience in body symptoms. They will look at both your symptoms and your life in general. This is not a sign your doctor thinks the symptoms aren’t real.

It’s also okay to say how you feel emotionally. Anxiety and low mood are common when living with symptoms, and they are treatable too.

Most people are helped by understanding how their symptoms are caused and what they can do to help themselves. There is much that can be done to live a better life. For anything medical, please consult your clinical provider.

Watching someone struggle with symptoms that doctors can’t easily explain is hard. Your belief and steady support can make a real difference to their recovery.

What can help

• Believe them. Their symptoms are real, even if tests are normal
• Celebrate small steps forward, and be patient with setbacks
• Encourage them to stay active and connected, at their own pace
• Help with practical things, like getting to appointments
• Learn about their symptoms, so you understand what they’re facing

Things to avoid saying

• “It’s all in your head”
• “Just stop worrying about it”
• “You look fine to me”
• “You’re doing it for attention”

If the person has health anxiety, giving reassurance again and again can keep the worry going. Instead, kindly acknowledge their feelings and encourage them to use their coping tools or speak to their provider.

Always get new, worsening or unusual physical symptoms checked by a doctor. Getting help early, as soon as you start to feel overwhelmed, often leads to better results.

It may be time to reach out if…

• Physical symptoms are stopping you from living normally
• You check your body or search symptoms many times a day
• You feel anxious, low or hopeless about your symptoms
• You spend a lot of time worrying about your health, even after normal tests

A good first step is your doctor or primary care provider. They can check your symptoms and refer you to specialists or a mental health professional. In the U.S., findtreatment.gov can help you find mental health services nearby.