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There is only one functional somatic syndrome

  • Simon Wessely (a1) and Peter D. White (a2)

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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Allen, L. A., Escobar, J. I., Lehrer, P. M., et al (2002) Psychosocial treatments for multiple unexplained physical symptoms: a review of the literature. Psychosomatic Medicine, 64, 939950.
Donta, S. T., Clauw, D. J., Engel, C. C., et al (2003) Cognitive behaviour therapy and aerobic exercise for Gulf War veterans' illnesses: a randomised controlled trial. Journal of the American Medical Association, 289, 13961404.
Gracely, R. H., Petzke, F., Wolf, J. M., et al (2002) Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis and Rheumatism, 46, 13331343.
Hotopf, M. (2003) Treating Gulf War veterans' illnesses — are more focused studies needed? JAMA, 289, 14361437.
Jason, L. A., Taylor, R. R., Kennedy, C. L., et al (2001) Chronic fatigue syndrome: comorbidity with fibromyalgia and psychiatric illness. Medicine and Psychiatry, 4, 2934.
Kendell, R. E. (1989) Clinical validity. Psychological Medicine, 19, 4555.
Rea, T., Russo, J., Katon, W., et al (1999) A prospective study of tender points and fibromyalgia during and after an acute viral infection. Archives of Internal Medicine, 159, 865870.
Romans, S., Belaise, C., Martin, J., et al (2002) Childhood abuse and later medical disorders in women: an epidemiological study. Psychotherapy and Psychosomatik, 71, 141150.
Wessely, S., Nimnuan, C. & Sharpe, M. (1999) Functional somatic syndromes: one or many? Lancet, 354, 936939.
White, P. D., Thomas, J. M., Amess, J., et al (1998) Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. British Journal of Psychiatry, 173, 475481.
Whitehead, W. E., Palsson, O. & Jones, K. R. (2002) Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology, 122, 11401156.
Whiting, P., Bagnall, A. M., Sowden, A. J., et al (2001) Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA, 287, 13601368.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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There is only one functional somatic syndrome

  • Simon Wessely (a1) and Peter D. White (a2)
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