Medically unexplained symptoms and persistent physical symptoms (PPS)

When tests are reassuring but your body still feels on high alert.

Many people experience ongoing physical symptoms that continue even after medical investigations have not identified a clear cause. The symptoms are real and can be frightening, exhausting and disruptive, especially when you are told “everything looks fine” yet nothing feels fine. It can also lead to repeated checking, searching for answers or feeling caught between reassurance and uncertainty.

Clinicians may describe this as persistent physical symptoms (PPS), functional symptoms or medically unexplained symptoms. Labels vary, but the experience is valid and there are understandable mind-body processes that can keep symptoms going over time.

Questions you might recognise

• Have tests come back normal, yet symptoms persist?
• Do symptoms flare during stress, pressure, conflict, or life transitions?
• Do you find yourself monitoring sensations, avoiding activities, or seeking repeated reassurance?
• Are symptoms affecting sleep, mood, work, or relationships?
• Do you feel stuck between “nothing is wrong” and “I still don’t feel well”?

Why symptoms can persist

When the nervous system detects threat, physical or emotional, it can shift into a protective state (fight/flight/freeze). Over time, the system can become sensitised: normal sensations feel louder, pain thresholds drop, and symptoms can feel unpredictable. This is not “all in your head”; it is a mind, body-cycle in which physiology, attention, emotion and coping strategies interact. Many persistent symptoms also follow a pressure-body loop. Emotional strain activates the system; if feelings are hard to access or are managed through pushing through, overthinking, people-pleasing or shutting down, the activation can be carried in the body as tension, pain or other symptoms. Symptoms then trigger fear and monitoring, which keeps the body on high alert and makes the cycle more self-reinforcing.

Common maintaining loops include:

• Worry and symptom monitoring (attention amplifies sensation)
• Avoidance and safety behaviours (short-term relief, long-term reinforcement)
• Chronic pressure (burnout, perfectionism, over-responsibility)
• Emotional overcontrol or shutdown (tension held in the body; feelings harder to process)
• Reassurance-seeking and repeated checking (brief relief that keeps uncertainty and threat sensitivity active)

Symptoms that often have a stress-body component

People seek support for symptoms such as:

• IBS-type difficulties and other gastrointestinal distress (pain, nausea, constipation/diarrhoea)
• Headaches/migraines, jaw/neck tension and persistent muscle tightness
• Chest tightness, palpitations or non-cardiac chest pain (once urgent causes have been excluded)
• Dizziness, light-headedness, faint feelings, tinnitus or visual disturbance
• Fatigue and persistent pain (including fibromyalgia-type presentations)
• Functional neurological presentations (e.g., non-epileptic seizures)
• Sexual pain or functioning difficulties

Therapy does not replace medical assessment or treatment. Where appropriate, we work alongside ongoing investigations or care and focus on reducing the fear and cycles that keep symptoms stuck.

How therapy can help

In therapy, we work collaboratively to understand your specific pattern and reduce the processes that maintain symptoms. This typically involves:

1. Mapping your symptom cycle

• Triggers, sensations, thoughts, emotions, behaviours, and context (work/relationships/life events).

2. Reducing symptom fear and threat responses

• So your nervous system can downshift rather than stay in chronic protection mode.

3. Changing maintaining behaviours

• Reducing avoidance, overchecking and repeated reassurance-seeking, and building safer exposure to life again.

4. Working with emotion and relationships

• Addressing the emotional and relational patterns that load the system (people-pleasing, overcontrol, shutdown, conflict avoidance).

5. Building regulation and resilience

• Improving steadiness in the body over time: less tension cycling, better sleep, improved tolerance of sensation and uncertainty.

Finding relief

Relief often begins with clarity: understanding what your body is doing, reducing the fear and struggle around symptoms, and building a more flexible internal system. If you would like to explore whether this approach fits your situation, you’re welcome to book an initial consultation to clarify what has been happening and what change could look like.

Next step: Contact me to arrange an initial consultation (in Central London, W1W or online).

Working with Dr Zach

I’m Dr Zach Vogiatzis, a Chartered Counselling Psychologist (HCPC registered) and the founder of The Psychology Clinics, offering therapy in Central London (W1W) and online. I specialise in burnout and high-pressure functioning, attachment/relationship patterns, and anxiety/low mood, including when stress shows up physically as stress-related and medically unexplained (persistent) physical symptoms (PPS). Therapy is active and collaborative, focused on change that holds beyond the therapy room.