Functional somatic symptoms and syndromes are a major health issue. They are common, costly, persistent and may be disabling. Most of the current literature pertains to specific syndromes defined by medical subspecialties. Indeed, each medical subspecialty seems to have at least one somatic syndrome. These include: irritable bowel syndrome (gastroenterology); chronic pelvic pain (gynaecology); fibromyalgia (rheumatology); non-cardiac chest pain (cardiology); tension headache (neurology); hyperventilation syndrome (respiratory medicine) and chronic fatigue syndrome (infectious disease). In 1999, Wessely and colleagues concluded on the basis of a literature review that there was substantial overlap between these conditions and challenged the acceptance of distinct syndromes as defined in the medical literature (Wessely et al, 1999). They proposed the concept of a general functional somatic syndrome. But is there any empirical evidence for such a general syndrome? Is it even a useful concept? Five years on, Professor Simon Wessely, King's College London, revisits this debate. He is opposed by Dr Peter White from St Bartholomew's Hospital and Queen Mary School of Medicine and Dentistry, London.
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