Functional somatic syndromes

The term functional somatic syndrome has been applied to several related sy ndromes characterized more by symptoms, suffering, and disability than by c onsistently demonstrable tissue abnormality. These syndromes include multip le chemical sensitivity, the sick building syndrome, repetition stress inju ry, the side effects of silicone breast implants, the Gulf War syndrome, ch ronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refract ory to reassurance, explanation, and standard treatment of symptoms. They s hare similar phenomenologies, high rates of co-occurrence, similar epidemio logic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be fo und in some patients with functional somatic syndromes, the suffering of th ese patients is exacerbated by a self-perpetuating, self-validating cycle i n which common, endemic, somatic symptoms are incorrectly attributed to ser ious abnormality, reinforcing the patient's belief that he or she has a ser ious disease. Four psychosocial factors propel this cycle of symptom amplif ication: the belief that one has a serious disease; the expectation that on e's condition is likely to worsen; the "sick role," including the effects o f litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic s yndromes includes sensationalized media coverage, profound suspicion of med ical expertise and physicians, the mobilization of parties with a vested se lf-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychoso cial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fea rs and pessimistic expectations, prolong their disability, and reinforce th eir sick role. A six-step strategy for helping patients with functional som atic syndromes is presented here.