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unexplained physical symptoms or MUPS (Engel and Katon 1999). Many who experience MUPS visit health care providers. A 1987 IOM report noted, “[F]or the patient and the health professional, such encounters can be frustrating because the symptom is often so very difficult to diagnose and treat. The absence of a diagnosable disease does not mean the absence of abnormalities, disturbances, or alterations in bodily functions. Thus, severe illness, illness behavior, and suffering can exist in the absence of a diagnosable disease. Effective treatment of patients with chronic pain [symptoms] requires that health care professionals view illness broadly and not only in terms of a narrow disease model” (IOM 1987: 3).

Engel and Katon described MUPS as arising from a four-part process. First, an individual must experience the symptom. Second, the person having the symptom must believe it has medical significance. Third, the symptomatic and concerned individual must behave in a way that indicates his or her suspicion of serious illness or disease (e.g., he or she seeks health care). Fourth, the clinician must determine that the symptoms are unexplained or partly explained by medical problems. Of course, persons who qualify for the diagnosis of chronic fatigue syndrome or fibromyalgia, for example, would meet the criteria for MUPS. Yet others who do not fall into the diagnosis categories reviewed previously in this report also fall into this category.

As noted by Wessley et al. (1999), patients seek help from doctors for symptoms and doctors diagnose diseases to explain them. One common way to explain these symptoms is to disaggregate them into a series of diagnostic categories. Wessley et al. argue, that the existence of specific syndromes such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome is largely an artifact of medical specialization and that similarities between these syndromes outweigh the differences. They suggest, instead, a dimensional classification. The intricacies of the debate between investigators who propose to aggregate these medically unexplained physical symptoms and those who propose to disaggregate them is beyond the scope of this report. Nevertheless, the debate is relevant because, to the degree that overlap across these diagnoses exists, the way is opened to more general strategies and services for their management.

The evidence of efficacy of some of the therapies for diagnoses reviewed previously may also be applicable to MUPS. Because there are no published reports to date of RCTs for the treatment of MUPS, however, direct evidence of efficacy is currently lacking. Despite the absence of RCTs for MUPS (apart from the above diagnoses), a general approach to the patient, as developed by health care providers who work with these patients, has evolved.