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date: 22 September 2021

Abstract and Keywords

Management of medically unexplained symptoms (MUS) is undergoing a period of change. We see this in the recent breakdown of consensus on mental health management of quintessential medically unexplained conditions (like myalgic encephalomyelitis/chronic fatigue syndrome), and in recent work in bioethics suggesting that the issue of biological versus mental health management of MUS is fundamentally an ethical matter. For these reasons, it is important to think carefully about ethical aspects of MUS management in psychotherapeutic settings. In the first part of this chapter, the authors show how ambiguity in the term “MUS” leads to routine conflation of diagnostic uncertainty with psychological diagnosis for unexplained symptoms in medical settings. The second part of the chapter explores evidence suggesting that substantial harm results from a failure to draw that distinction in medical settings, and clarifies the psychotherapist’s obligations to avoid those harms. The authors then explore the risk for psychological harms when psychotherapists conflate diagnostic uncertainty with psychological diagnosis. Finally, they consider challenges to informed consent in psychotherapy for MUS. The chapter concludes with principles for ethical psychotherapeutic management of MUS.

Keywords: medically unexplained symptoms (MUS), treatment, psychotherapy, CBT, misdiagnosis

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