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Definitions:

Understanding the language around medically unexplained and overlooked conditions can be difficult. Here's a guide to some of the key terms we use:

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Forgotten Patient:

A person known to healthcare professionals with ongoing medical issues, whose problems are not actively being addressed — often falling through the cracks in the healthcare system.

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Overlooked Diseases:

​Diseases or conditions for which there is little professional interest in prevention, diagnosis, treatment, or cure — despite a clear underlying pathological process.

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Medically Unexplained Symptoms (MUS):

Symptoms for which no identifiable disease is found after appropriate investigation.
This does not mean the symptoms aren’t real or that no physical process is involved — only that a clear medical cause hasn’t been discovered yet.

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🔸 Why the term is controversial:
MUS is falling out of favour because:

  • It doesn’t capture complexity (e.g. severity, duration, underlying mechanisms)

  • It’s often misinterpreted to mean symptoms are "all in the mind"

  • Within psychiatry, it has been linked to psychological causes — which may apply in some cases, but not all

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Many clinicians now prefer alternative terms, especially when symptoms are persistent or complex.

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Persistent Physical Services (PPS):

A more widely used umbrella term for distressing physical symptoms — such as pain, fatigue, or breathlessness — that last for several months or more, regardless of the cause.

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Persistent Somatic Symptoms (PSS):

Often used interchangeably with PPS.
“Somatic” means “of the body,” but some patients find this term off-putting, as it can imply a mind–body split, or that the symptoms are not real.

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Somatic Symptoms Disorder (PSD):

A diagnosed condition in which a person’s thoughts, feelings, or behaviours related to their symptoms become excessive or disproportionate — regardless of whether a medical cause is found.

📌 This is not faking or exaggerating.
The person is genuinely suffering and believes they are unwell.
SSD is linked with serious distress, disability, and healthcare burden.

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Unbearable Unexplained Symptoms (UUS):

A term coined by Dutch researchers (Witte Raven, van Leeuwen et al. 2019) to describe the emotional impact on doctors when faced with a patient who:

  • Reports serious symptoms

  • Has no clear diagnosis

  • Triggers concern that something important is being missed

“It just can’t be true that there’s nothing wrong… What am I overlooking?”
UUC reflects the first stage of a diagnostic journey — one that may lead to discovery, or at least a more targeted referral.

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Causes of Persistent Physical Symptoms

These symptoms may arise from:

  • Infections

  • Injuries

  • Medical diseases

  • Stressful life events

  • Or appear spontaneously (de novo)

Over time, clear medical explanations may become harder to find. A range of biological and psychological factors can contribute, including:

  • Persistent inflammation

  • Microbiome or immune dysfunction

  • Epigenetic influences

  • Depression or anxiety

  • Symptom-focused behaviours and avoidance

  • Early trauma

  • Learned responses and expectations

These factors often overlap across conditions and require a broad, holistic approach to care.

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