Physician perceptions of medically unexplained symptoms in adolescent patients presenting to the emergency department

Adolescents presenting with medically unexplained symptoms (MUS) in non-mental healthcare settings, particularly Emergency Departments (EDs), pose diagnostic challenges necessitating a comprehensive bio-psycho-social approach. Amid the youth mental health crisis, recognising psychological distress is imperative. This study delved into physicians' perceptions and diagnostic tendencies regarding such cases, exploring the potential overshadowing of psychosomatic presentations by medicalized diagnoses in EDs. Our study involved 74 physicians, representing 82% of eligible respondents in the Paediatric Emergency Medicine Department, and was conducted using an online questionnaire examining perceptions of case scenarios with psychosomatic presentations. Results disclosed a prevalent inclination toward medical diagnoses, with less than 10% of physicians considering psychosomatic conditions in specific scenarios. Interestingly, psychosomatic diagnoses were more probable for symptoms like headaches, shortness of breath, and chest pain. The study uncovered a possible bias among physicians towards medical diagnoses in EDs for adolescents with MUS, possibly stemming from physicians’ focus on physical care, diagnostic uncertainties, cognitive biases, and concerns about stigmatisation. Adolescents with MUS seeking assistance in non-mental health settings may encounter delayed mental health diagnoses and interventions. Psychosomatic symptoms could signify stressors or underlying mental health disorders. Recognising psychosocial distress early on is crucial for optimal mental health outcomes. Consequently, the study advocates for a paradigm shift towards a holistic bio-psychosocial approach in both medical education and practice. •Adolescents with psychosocial difficulties commonly present with psychosomatic symptoms because of the "mind-body" connection.•Medically unexplained symptoms are "red flags" for psychological distress.•This study explores how ED doctors diagnose MUS, generally endorsing medically rather than psychosomatic diagnoses.•Findings highlight the need for a holistic bio-pyscho-social approach in medical education and practice for MUS.•Early identification of distressed adolescents is crucial to address the youth mental crisis.