Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors

  • Nicole SullivanEmail author
  • L. Alison Phillips
  • Wilfred R. Pigeon
  • Karen S. Quigley
  • Fiona Graff
  • David R. Litke
  • Drew A. Helmer
  • Joseph F. Rath
  • Lisa M. McAndrew
Full length manuscript



Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship.


The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness beliefs, behavioral responses to illness, and disability were assessed through self-report questionnaire. Data were analyzed using mediation analysis.


Threat-related beliefs predicted greater disability through decreased activity and increased practical support seeking. Protective beliefs predicted less disability through reductions in all-or-nothing behavior and limiting behavior.


These outcomes suggest that all-or-nothing behavior, limiting behavior, and practical support seeking are important in the perpetuation of disability among those with MUS. This has implications for improving MUS treatment by highlighting potential treatment targets.

Trial Registration Identifier: NCT02161133


MUS Disability Illness beliefs Illness behaviors 



The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Funding information

This work was supported by Merit Review Award #I01CX001053 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development, and a Career Development Award # IK2HX001369 from VA Health Services Research and Development Program. It was also supported by the VA NJ War Related Illness and Injury Study Center and VA Office of Academic Affiliation. Identifier: NCT02161133.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that there is no conflict of interest.


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Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  • Nicole Sullivan
    • 1
    Email author
  • L. Alison Phillips
    • 2
  • Wilfred R. Pigeon
    • 3
  • Karen S. Quigley
    • 4
    • 5
  • Fiona Graff
    • 1
  • David R. Litke
    • 1
    • 6
  • Drew A. Helmer
    • 1
    • 7
  • Joseph F. Rath
    • 6
    • 8
  • Lisa M. McAndrew
    • 1
    • 9
  1. 1.War Related Illness and Injury Study CenterVeterans Affairs New Jersey Health Care SystemEast OrangeUSA
  2. 2.Department of PsychologyIowa State UniversityAmesUSA
  3. 3.Center of Excellence for Suicide PreventionCanandaigua VA Medical CenterCanandaiguaUSA
  4. 4.Edith Nourse Rogers Memorial VA HospitalBedfordUSA
  5. 5.Department of PsychologyNortheastern UniversityBostonUSA
  6. 6.Department of Rehabilitation MedicineNew York University School of MedicineNew YorkUSA
  7. 7.Department of MedicineRutgers University- New Jersey Medical SchoolNewarkUSA
  8. 8.Rusk Institute of Rehabilitation MedicineNew York University Langone Medical CenterNew YorkUSA
  9. 9.Department of Educational and Counseling PsychologyUniversity at AlbanyAlbanyUSA

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