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Eye movement desensitisation and reprocessing therapy for medically unexplained symptoms: a case study

Tom Hulme Clinical nurse specialist EMDR and cognitive behaviour therapist Correspondence:



This article describes how eye movement desensitisation and reprocessing therapy (EMDR) was used to treat a woman with long-term abdominal pain and vomiting that had no organic cause and falls under the generic description of medically unexplained symptoms.

Key words

Eye movement desensitisation and reprocessing therapy, EMDR, medically unexplained symptoms, MUS, case study, post-traumatic stress disorder, PTSD


Medically unexplained symptoms

Medically unexplained symptoms (MUS) affect between 25% to 50% of all presentations to primary and secondary care, and are characterised by somatic symptoms that have no obvious medical explanation (Kroenke and Price, 1993).

These patients are often difficult and costly to treat, having disproportionately elevated rates of medical care utilisation (Barsky et al, 2005). This includes outpatient visits, hospitalisations and total healthcare costs.

Their utilisation is particularly maladaptive and suboptimal because these patients tend to ‘doctor shop’, consult multiple physicians for the same problem, use emergency services and tend not to keep scheduled appointments (Barsky et al, 2005).

A diagnosis of MUS is generally given once all other possible pathology have been excluded (Henningsen et al, 2007).

Almost all medical specialities have their own MUS or functional disorders: irritable bowel syndrome in gastroenterology; fibromyalgia in rheumatology; chronic fatigue syndrome in infectious disease; noncardiac chest pain in cardiology; and non-epileptic seizures in neurology.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is defined as a severe anxiety disorder that occurs when a person is exposed to actual or threatened death, serious injury or sexual violence (American Psychiatric Association, 2013).

The exposure can be direct, witnessed or indirect, e.g. by hearing of a relative or close friend who has experienced the trauma.

A diagnosis of PTSD can only be made if the person continues to experience pervasive symptoms for at least one month after the traumatic event. Core symptoms include:

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About Mental Health Nursing

The February/March 2018 #MHNjournal highlights include: - Mother care? Counting the cost of perinatal mental ill health - MHN Editorial Board member, Nicky Lambert is Looking back, looking forward - Eye movement desensitisation and reprocessing therapy for medically unexplained symptoms: a case study by Tom Hulme - The Mental Health & Smoking Partnership: tackling health inequality by Hazel Cheeseman - MHN Student Focus: Bethan Cumber on helping to inspire the nurses of the future - Inside the mind of... Jay Watts - Our regular updates from LPO Dave Munday and news from the mental health nursing world, including news of our 2018 support of Nursing in Practice events.