Medically unexplained symptoms are physical symptoms that have no currently known physical pathological cause. They are common (accounting for as many as 1 in 5 of new primary care consultations) and can impair function and cause significant distress to patients.

This longitudinal cohort study conducted by researchers from London set out to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.

The study followed 410 patients with medically unexplained symptoms from 10 general practices in the UK. Patients answered a baseline questionnaire which assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. They were then consulted further via a telephone interview which measured health worry, GP management and their overall satisfaction with the consultation. The main outcome was annual GP consultation rate.

Here’s what the researchers found:

• 18% of consecutive attenders had medically unexplained symptoms (MUS)
• The MUS group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year
• The prevalence of insecure attachment was 28% (95% CI 23-33).
• A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]
• The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]

The authors concluded:

Patients with medically unexplained symptoms who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.

Taylor RE, Marshall T, Mann A, Goldberg DP. Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychol Med. 2011 Aug 31:1-10. [Epub ahead of print] [PubMed abstract]