Non-specific physical disorders (functional somatic syndromes)
ICD codes: F45 F48 What is the ICD Code?
It is not always possible to find a medical cause for somatic symptoms. For example, many people experience pain, digestive problems or circulatory disorders with no clear explanation. If the problems persist, it is important to reconsider the ways to deal with stress and conflict.
At a glance
- Some people have persistent somatic symptoms that doctors are unable to find a cause for.
- Unexplained symptoms can be unsettling but often disappear of their own accord after a few weeks.
- Just because no physical cause is found does not mean that there is no reason for the symptoms.
- According to estimates, about 10 percent of the population have symptoms with no clearly diagnosable cause.
- If such symptoms persist for a long time, they can cause severe psychological strain and stress.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What are functional somatic syndromes?
Many people suffer from conditions like headaches, diarrhea or dizziness. These can be unpleasant but usually go away again after a while. A specific cause can often be determined for persistent symptoms. In some cases though, doctors are unable to find a clear physical cause, such as inflammation or injury. Such cases are referred to as functional somatic syndromes.
Having symptoms with no known cause can be unsettling. However, these often go away again within a few weeks or can be alleviated. People who experience functional somatic syndromes should try to remain active during everyday life and find ways to cope with the symptoms.
If functional somatic syndromes persist and are extremely troublesome, the people affected may be able to obtain further assistance, for example from a psychotherapist.
Taking medication over the long term has little if any positive impact. It can be very frustrating for people with persistent symptoms if doctors are unable to find the reason for them. However, this does not mean that the symptoms are in their head or nothing can be done.
What are the symptoms of functional somatic syndromes?
There are many different functional somatic syndromes. Common examples include:
- pain, especially headaches, stomach ache, back ache and muscle pain
- stomach and bowel problems such as nausea, vomiting, bloating, diarrhea and constipation
- circulatory disorders: these express themselves through symptoms like drowsiness, heart palpitations and anxiety
- fatigue, tiredness and trouble concentrating
- shortness of breath or panic-like attacks where the breathing dramatically speeds up and deepens (hyperventilation)
- cramps and muscle tensions
- sensory disorders such as itching, tingling and numbness
- bladder problems such as severe urinary urgency or painful urination
The physical symptoms can be joined by anxiety and depression. Some people with functional somatic syndromes can also feel like they have foreign bodies inside them or physically feel something seemingly conspicuous on their bodies.
Disorders like fibromyalgia or irritable bowel syndrome can cause unpleasant symptoms for which no real explanation can initially be found. Such disorders therefore have many similarities to functional somatic syndromes.
What causes functional somatic syndromes?
The fact that no physical cause is found does not mean that symptoms occur without reason. Often, a mixture of physical and mental factors is likely to be involved. These include overload, previous illnesses, family history, difficult personal circumstances or interpersonal conflicts, to name but a few.
People experience somatic symptoms with varying levels of intensity and deal with them differently. Some people find them to be very severe and restrictive; others pay little attention to them. The extent to which functional somatic syndromes affect people’s lives also depends on how the people affected deal with them.
The term functional somatic syndromes is also used because it is possible for an organ to be healthy but still not work properly. For example, someone could have digestive problems even though their intestines are neither injured nor inflamed. It may be that the intestines are not working properly due to stress. This can result in diarrhea, bloating or constipation.
How common are functional somatic syndromes?
According to estimates, about 10 percent of the population have symptoms for which no clear causes can be found. Women are affected twice as often as men. One possible reason for this is that pain perception can depend on hormones. Social and cultural factors can also play a role – for example different role expectations and life experiences. Furthermore, women are more likely to seek medical assistance than men.
How do functional somatic syndromes develop?
Functional somatic syndromes are not generally dangerous. They are often mild and temporary. In some cases though, they can seriously affect people and last for a long time. Functional somatic syndromes can affect people both physically and mentally. They can also impair family and working life – or even make it impossible for people to do their current job.
Many people with persistent somatic symptoms find it hard to remain active. They often also believe that they have to rest due to the symptoms. This can lead to a vicious circle as certain problems get worse when people remain inactive. This is the case with muscle and joint pain, for example.
Long-term functional somatic syndromes can also result in severe psychological strain and stress. About half of all those affected develop depression or anxiety disorders.
However, many people also succeed in remaining calm despite their problems. To do this, it can help to note that the intensity of the symptoms varies. Remaining optimistic and being confident that the symptoms will recede can also help those affected.
People with functional somatic syndromes sometimes feel like they are not taken seriously by doctors and are left to fend for themselves. This can be one reason why people often seek alternative medical opinions and frequently change medical practice.
Although functional somatic syndromes can significantly impair people’s quality of life, they do not usually affect their life expectancy. On average, people with functional somatic syndromes live for just as long as those without them.
How are functional somatic syndromes diagnosed?
To diagnose functional somatic syndromes, the doctor first has a consultation with the patient. A physical examination then occurs to determine the symptoms more precisely. This can be followed by a blood sample or ultrasound examination. Once these have been done, the doctor is often able to better assess whether a clear cause is probable and if treatment is required. During the examination, common causes of the symptoms are first investigated. The doctor will also pay attention to indications of serious illnesses.
The need for further investigations or referral to a specialist medical practice depends on several factors – for example, the severity of the symptoms and how they develop. As functional symptoms often improve after a few weeks doctors may not perform all the possible examinations and tests immediately. Further examinations are often only performed if the symptoms persist for longer or get worse. It is rare for organic causes or an illness to be diagnosed after all at a later date.
Important: It is not necessarily useful to perform all of the possible investigations. One reason for this is that some investigations are associated with health risks. In addition, the more investigations are performed, the higher the risk of false suspected findings where an apparent cause is discovered that is later found to be unjustified or harmless. Such findings can cause patients unnecessary concern. They can also lead to further investigations that are not actually required.
In the case of persistent functional somatic syndromes, it is important to remain in contact with a doctor. Even if no clear cause is found, it is still possible to discuss what could contribute to the symptoms or make them worse. It is also possible to discuss what could help to alleviate the symptoms. The aim of the medical consultation is to find a preliminary explanation for the symptoms – as well as to determine treatment options and ways to better deal with them. These approaches can be reviewed at future medical consultations and adapted if necessary. This process also makes it possible to consider other explanations or approaches. Working with a doctor to find explanations and useful measures is often the best solution with functional somatic syndromes.
If the functional somatic syndromes last for longer and greatly affect the patient, it can be useful to obtain advice from a psychosomatic or psychotherapeutic practice or clinic. Psychosomatic facilities usually specialize in treating functional somatic syndromes.
How are functional somatic syndromes treated?
Symptoms without a clear cause often improve without treatment within a few weeks. As a result, doctors initially hold back with treatments. If the symptoms are only minor, they often simply start by offering tips as to how the patient can cope with them better during everyday life.
In the case of functional somatic syndromes, doctors often recommend that patients:
- are physically active.
- continue to have a social life, meet friends and do their hobbies.
- identify and avoid things that are too much for them.
- clarify conflicts and consider ways to cope with stress and strain.
- observe what alleviates the symptoms.
- are careful to lead a healthy lifestyle and get plenty of sleep.
Medication can sometimes be used as a treatment option, for instance in cases of pain or gastrointestinal symptoms, but usually only for a short period.
Some patients find that the symptoms persist for longer or affect several organs. If they become a severe problem, psychotherapeutic support may be useful. In certain cases, other approaches such as physiotherapy exercises, nutritional advice and occupational therapy are also possible. Patients can also try relaxation techniques or mindfulness training to cope better with the stresses.
Important: It is more useful for people with functional somatic syndromes to be active than to passively rely on external measures like massages. If at all, these are only recommended temporarily and in a complementary function. It is more useful to find activities with a sustainable effect: for example through more exercise and better stress management. Some patients have to force themselves to do this at first and need to be patient. Often, they get used to it quickly and feel better though. Sport should not push people too much, but primarily be fun and offer positive experiences.
Those affected by persistent and severe functional somatic syndromes usually need patience. It is therefore often useful to set small goals. It can also be advisable to primarily work on leading an active life – despite the symptoms. This means staying active, distracting themselves and initially just expecting the symptoms to recede slightly.
The main people to consult about functional somatic syndromes are general practitioners.
Many of these have an additional qualification in “psychosomatic basic care”. This means that they are specially trained to deal with this topic. If necessary, the doctor will coordinate the treatment with medical practices or clinics.
Further information on matters relating to functional somatic syndromes and what can help can be found at gesundheitsinformation.de.
Is rehabilitation useful?
Only a few people with functional symptoms need rehabilitation. However, it can be useful in the case of an incapacity for work, for example. In such cases, rehab can help patients get back to work. Rehabilitation can also have other goals too though, such as:
- preventing the symptoms from getting worse.
- encouraging patients to have a social life.
- maintaining patients’ ability to work.
Rehabilitation can focus on different things from case to case but always involves both physical and psychological measures.
The nature and severity of the health problems determine whether outpatient or inpatient treatment is required. The German pension insurance organization (Deutsche Rentenversicherung) is primarily responsible for medical rehabilitation although health and statutory accident insurance providers can sometimes also be the right points of contact.
What other information is available?
People with functional somatic syndromes often use many different sources of information, including the internet. However, they should remain skeptical and question the quality of the information provided. Those who are not careful can easily find that they are taking advice from charlatans or being made false promises. Checklists can help to assess the quality of information.
People affected by functional somatic syndromes can also contact advisory services and self-help groups. The German Psychotherapists’ Association (Deutsche Psychotherapeuten-Vereinigung) offers a search function on its website that can be used to find suitable psychotherapists. The appointment service offices of the National Association of Statutory Health Insurance Providers (Kassenärztliche Bundesvereinigung) also acts as a further point of contact and arranges appointments at medical practices. The Alliance of Rare Chronic Diseases (Allianz Chronischer Seltener Erkrankungen – ACHSE) is a further good source of information in relation to rare conditions.
- Deutsches Kollegium für Psychosomatische Medizin (DKPM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM). Funktionelle Körperbeschwerden. S3-Leitlinie. Langfassung. AWMF-Registernummer 051-001. 07.2018. Aufgerufen am 03.07.2020.
In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at: