Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors
Abstract
Background 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.Methods 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.Results 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.Conclusions 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 ClinicalTrials.gov Identifier: NCT02161133.
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Maladaptive illness behaviours are known maintaining factors for FSS.
“and maladaptive illness behaviours (e.g. avoidance, control and ‘all-or-nothing’ behaviour) [17].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [17]
The Discussion (p. 6) links all-or-nothing and limiting behaviours to worse disability in veterans with long-standing medically unexplained symptoms, and the Introduction (p. 2) describes activity avoidance as associated with greater disability. But the paper treats perceived control as a protective illness belief, not a maladaptive behaviour. Its cross-sectional findings also do not establish that these behaviours maintain symptoms across all functional somatic syndromes. (LLM, conf=0.86)
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- Authors
- Sullivan, N., Phillips, L. A., Pigeon, W. R., Quigley, K. S., Graff, F., Litke, D. R., Helmer, D. A., Rath, J. F., & McAndrew, L. M.
- Affiliations
- VA New Jersey Health Care System (US)
- Iowa State University (US)
- Canandaigua VA Medical Center (US)
- Northeastern University (US)
- Rutgers, The State University of New Jersey (US)
- NYU Langone Health (US)
- University at Albany, State University of New York (US)
- Corresponding author
- Sullivan, Nicole
- ORCID
- Venue
- International Journal of Behavioral Medicine
- Published
- 2019-11-07
- Volume
- 26
- Issue
- 6
- Pages
- 665-672
- ISSN
- 1070-5503 (ISSN-L)
- 1532-7558
- OpenAlex
- W2984988076
- Cited by
- 25
- References
- 37
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 8
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Iowa State University Digital Repository (Iowa State University) (submittedVersion)
- Scholars Archive - University at Albany (University at Albany, State University of New York) (submittedVersion)
- Funders
- VA Health Services Research and Development Program (IK2HX001369)
- United States Department of Veterans Affairs Clinical Sciences Research and Development (I01CX001053)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- medically unexplained symptoms, illness beliefs, illness behavior, disability, asymptotic behavior, veterans, mediation, chronic pain
- MeSH terms
- Medically Unexplained Symptoms, Adaptation, Psychological, Adult, Culture, Female, Humans, Male, Middle Aged, Occupational Diseases, Surveys and Questionnaires, Somatoform Disorders, Veterans, Health Behavior, Randomized Controlled Trials as Topic
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