Medically Unexplained Symptoms: A Systematic Umbrella Review of Current Terminology and Reported Rationales

This review addresses current naming conventions for Medically Unexplained Symptoms (MUS) through a systematic umbrella review. Terminology used and provided rationales were considered.

Registered with PROSPERO (CRD42024526020), this review searched eight key databases, last on January 28, 2025. Reviews including medically unexplained symptoms (or synonym or subtype) in their systematic search terms were included (N=422).

A total of 577 references to 111 terms were made across the reviews, with numerous reviews using the same overarching terms, including "functional" (n=233), "somatic" (or variants thereof, n=51) and "medically unexplained" (n=28). Thirty percent of terms (n=179) were to specific syndromes or terms that did not group together under an overarching term, suggesting substantial variability in terms, even though over 60% of authors were primarily associated with just three disciplines - medicine, allied health, and psychology. A subset of 23 reviews provided rationales that underwent a content analysis and ROBIS risk-of-bias assessment. This analysis showed that rationales tended to (1) highlight differences between psychological, psychiatric and other medical fields (n=7), (2) focus on the patient perspective and patient-practitioner therapeutic relationship (n=10), or (3) follow broad and/or commonly used terms (n=7).

The current landscape of terminology used for MUS remains varied, nuanced, and inconsistent between disciplines. Moving forward to more universal language accepted and used by both patients and practitioners would aid in the diagnosis, management, and treatment of MUS.