SOMATIZATION AND FASHIONABLE DIAGNOSES - ILLNESS AS A WAY OF LIFE

The history of ''nondisease'' dates back, at least 4000 years, to earl y descriptions of hysteria. More recently somatization became a part o f the official diagnostic nomenclature by creation of the DSM III cate gory, ''somatoform disorders.'' Somatization can serve as a rationaliz ation for psychosocial problems or as a coping mechanism, and for some illness, becomes a way of life. One variation of somatization can be the ''fashionable diagnosis'', for example, fibromyalgia, multiple che mical sensitivities, dysautonomia, and, in the past, ''reactive hypogl ycemia''. These disorders are phenomenologically related to environmen tal or occupational syndromes and mass psychogenic illness. Fashionabl e illnesses are characterized by (i) vague, subjective multisystem com plaints, (ii) a lack of objective laboratory findings, (iii) quasi-sci entific explanations, (iv) overlap from one fashionable diagnosis to a nother, (v) symptoms consistent with depression or anxiety or both, (v i) denial of psychosocial distress or attribution of it to the illness . Fashionable diagnoses represent a heterogeneous collection of physic al diseases, somatization, and anxiety or depression. They are final c ommon symptomatic pathways for a variety of influences including envir onmental factors, intrapersonal distress and solutions to social probl ems. A fashionable diagnosis allows psychosocial distress to be comfor tably hidden from both the patient and the physician, but premature la beling can also mask significant physical disease. Hysteria remains al ive and well and one contemporary hiding place is fashionable illness.