Medically Unexplained Symptoms


Full text NHG Guideline on Medically Unexplained Symptoms (pdf)

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The NHG Guideline on medically unexplained symptoms (MUS) provides recommendations on the diagnosis and management of adult patients with MUS. This is defined as physical symptoms that last for longer than a few weeks and which cannot be satisfactorily explained after adequate medical examination.

The guideline distinguishes between mild, moderate, and severe MUS. Assessment of MUS severity is based on five dimensions of symptoms, i.e. the somatic, cognitive, emotional, behavioral, and social dimensions.

Treatment is offered as stepped care and tailored to the individual patient. Good doctor–patient relationship and communication are essential for the management of MUS. Management is focused on providing information and advice aiming at increasing activities in a time-contingent manner.


The guideline program of the College is designed for GPs in the context of the Dutch healthcare system. It makes no warranties concerning the efficacy of the guidelines used in other countries. The information is for educational and/or professional use only and is provided in good faith without any express or implied warranty. The College does not accept responsibility for any loss or damage occasioned by use of the information contained on the website nor from any access to the website. All access and use is at the risk of the end-user.

Additional information


Tim Olde Hartman, Nettie Blankenstein, Bart Molenaar, David Bentz van den Berg, Henriëtte van der Horst, Ingrid Arnold, Jako Burgers, Tjerk Wiersma, Hèlen Woutersen-Koch



Revision Date

May 2013