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



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

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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.


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.

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Correspondence to Nicole Sullivan.

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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.

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Sullivan, N., Phillips, L.A., Pigeon, W.R. et al. Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors. Int.J. Behav. Med. 26, 665–672 (2019).

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  • MUS
  • Disability
  • Illness beliefs
  • Illness behaviors