In the absence of defined disease, but also on top of it, functional somatic symptoms indicate subjective distress. They have multidimensional, individual origins and their course is heterogeneous. We do not understand their exact psychophysiological pathways yet, but we know that stressors, attention/expectation and the way we handle them matter a lot. This applies especially to consultation-liaison psychiatry, where patients rarely have one single and simple problem, and there are frequent mismatches between the subjective symptom burden and objective findings.

Management of functional somatic symptoms should be interdisciplinary, mixing diagnostic and therapeutic, physical and psychological techniques. Treatment is based on empathy, psychoeducation, activation and the development of a bio-psycho-social explanatory model. Symptom relief and co-morbid illness can require medication, but passive interventions should only be temporary, with weighted risks and benefits. More severe cases need a multimodal approach or psychotherapy, carefully addressing the embodied self with all its experiences, attitudes and resources.