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“Unexplained” Somatic Symptoms, Functional Syndromes, and Somatization: Do We Need a Paradigm Shift?

Michael Sharpe, MA, MRCP, MRCPsych; and Alan Carson, MB, MRCPsych, MPhil
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From University of Edinburgh and Royal Edinburgh Hospital, Edinburgh, United Kingdom. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.


Copyright ©2004 by the American College of Physicians

Grant Support: By the University of Edinburgh.

Requests for Single Reprints: Michael Sharpe, MA, MRCP, MRCPsych, University Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom; e-mail, michael.sharpe@ed.ac.uk.

Current Author Addresses: Dr. Sharpe: University Department of Psychiatry, Kennedy Tower Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.

Dr. Carson: Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.


Ann Intern Med. 2001;134(9_Part_2):926-930. doi:10.7326/0003-4819-134-9_Part_2-200105011-00018
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Medically unexplained functional or somatization symptoms are somatic disorders that are not adequately explained by physical disease processes. The way in which these disorders have been understood and managed has varied over the history of medicine. However, only in the past 100 years has the “mental” explanation predominated. A benefit of this trend has been the development of effective treatments in the form of “antidepressant” drugs and cognitive–behavioral therapies; a cost has been limited integration of these treatments into medical practice and lack of acceptability to patients.

We suggest that there is much to learn from physicians of the pre-Freudian era. Their etiologic theories are now supported by new scientific evidence, and their clinical practice provided ways of making psychological treatment acceptable to patients. We propose a paradigm shift in which unexplained symptoms are remedicalized around the notion of a functional disturbance of the nervous system and treatments currently considered “psychiatric” are integrated into general medical care.

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