Functional somatic syndrome
| Functional somatic syndrome | |
|---|---|
| Specialty | Psychiatry |
Functional somatic syndrome (FSS) is any of a group of chronic diagnoses with no identifiable organic cause. Fibromyalgia is the leading FSS condition, among many. FSS conditions are highly prevalent, but little is known about their etiology.
Biological markers for the FSS diagnoses are non-existent, making the categorization difficult. Diagnosis is by exclusion.
Definition and Terminology
[edit]FSS refers to disturbances in bodily functioning where aetiology is unknown,[1] including that psychogenesis is not assumed.[2]
Related terms
[edit]"Medically unexplained physical symptoms" include FSS situations, but also situations where the symptoms are sporadic and where psychogenesis may be suspected.[3]
"Persistent physical symptoms"[4] includes FSS situations but also situations where persistent physical symptoms are caused by a known illness, such as arthritis.
In somatic symptom disorder chronic physical symptoms, which may or may not be linked to a known illness, coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. In FSS these features are not present.
Signs and symptoms
[edit]Functional somatic syndromes are characterized by ambiguous, non-specific symptoms that appear in otherwise-healthy people. Overlap in symptomology exists across diagnoses, including gastrointestinal issues, pain, fatigue, cognitive difficulties, and sleep difficulties. Some have proposed to group symptoms into clusters[5][6] or into one general functional somatic disorder given the finding of correlations between symptoms and underlying etiologies.[7][8]
Pre-diagnosis contact with health systems
[edit]A large (n = 43,676) 2020 study found that 5 years prior to diagnosis, FSS patients consulted more frequently for a range of psychological and somatic conditions than did controls. Around half this cohort were ME/CFS patients (normally not termed an FSS).[9]
FSS conditions
[edit]FSS disorders include
- fibromyalgia (FM),[10]
- temporomandibular disorder,
- irritable bowel syndrome,[10][11]
- lower back pain,
- tension headache,
- atypical face pain,
- non-cardiac chest pain,
- insomnia,
- palpitation,
- dyspepsia,
- dizziness.[12]
- certain claims of food allergies[10] (when no true allergy can be demonstrated)
- Gulf War syndrome[10]
- certain claims of hypoglycaemia[10] (symptoms appearing when the blood sugar is normal)
- Chronic Lyme disease[10]
- Multiple chemical sensitivity[10]
- Sick building syndrome[10]
- Chronic whiplash[10]
Overlap of FSS conditions
[edit]A large overlap of symptoms exist between the FSS diagnoses, causing high rates of comorbidity between them; the prevalence of comorbid FSS diagnoses ranges from 20% to 70%, while comorbid affective disorders with a fibromyalgia diagnosis ranges from 20% to 80%.[13]
ME/CFS not an FSS
[edit]ME/CFS[14] is classified by major health bodies such as the NAM, WHO, and NIH as an organic disease,[15][16][17] and there are consistent findings of biological abnormalities, although the aetiology remains unclear.
Prevalence
[edit]Studies have found prevalence in the general population of having at least one FSS of 16.3% (n = 9656),[18] and 9.3% (n = 3054).[19]
Comorbidity
[edit]PTSD
[edit]Rates of PTSD are roughly 9.5–43.5% higher in people seeking treatment for a functional somatic syndrome as opposed to the general population.[20]
Potential causes
[edit]Psychological factors
[edit]Patients with somatic syndromes such as fibromyalgia and irritable bowel syndrome have significantly higher rates of both physical and sexual abuse prior to the onset of their physiological symptoms, as well as higher rates of previous emotional abuse, emotional neglect, and physical neglect compared to the general population.[21] Further, childhood trauma such as sexual abuse or maltreatment can indicate an increased propensity for later somatic syndrome onset.
"Attentional bias" has been posited as the psychological mechanism by which trauma and somatic symptoms are tied.[22][23] The concept of attentional bias refers to the idea that traumatic events can cause individuals to become more attuned to their bodies, thus intensifying the perception of pain, fatigue, and other common somatic symptoms.[23] The initial traumatic event is interpreted as a threat to the body, and therefore the stress-response of the body takes on a new, heightened awareness to any potential subsequent threats. This attentional bias leads to a "health anxiety," where the patient becomes increasingly concerned that common somatic symptoms are related to a physical disease or injury, and therefore, another potential bodily threat.[22] An initial perception of lost control can further lead to this attentional bias; sense of control is negatively associated with symptom reporting, suggesting that somatic symptoms are more closely monitored when psychologically recovering from an incident of lost control.[24] Functional Somatic Syndromes are thought to be a result of conditioned hyperarousal following a trauma; victims are conditioned to respond more sensitively to the somatic symptoms following a trauma by their attention to and reinforcement of the symptom existence. This feedback loop is similar to that of panic disorder, in which fear of a subsequent panic attack causes an increased hyper-vigilance towards, and exacerbation of, certain physiological symptoms, such as heart palpitations, dizziness, and breathlessness.[25]
Biological factors
[edit]One hypothesis implicates the hypothalamic–pituitary–adrenal axis (HPA axis) in the manifestation of somatic symptoms following trauma. The HPA axis plays a major role in moderating the body's stress response to both emotional and physical pain, relating to both the experience of psychological symptoms prevalent following trauma as well as the physiological symptoms prevalent in FSS conditions.[26] When an individual experiences a traumatic event, the HPA-axis causes the increased release of cortisol, activating the sympathetic nervous pathway and causing negative feedback to be sent to the hypothalamus and pituitary gland. In people who have experienced significant trauma, this reaction can become dysfunctional and can cause a chronic decrease in cortisol production, though the rates of this decrease in cortisol levels varies across different types and frequencies of trauma.[27]
Diagnosis
[edit]Diagnosis of a FSS is usually a diagnosis of exclusion, where physicians rule out other disorders that could explain the dysfunctions being experienced.[28]
Management and Treatment
[edit]CBT can be helpful for FSS. Meds such as antidepressants may play a role.[29][30]
History
[edit]The term functional somatic syndrome was used in a 1999 paper.[31]
References
[edit]- ^ https://www.nature.com/articles/s41598-020-66685-4?
- ^ Mayou R, Farmer A (August 3, 2002). "Functional somatic symptoms and syndromes". BMJ. 325 (7358): 265–268. doi:10.1136/bmj.325.7358.265. PMC 1123778. PMID 12153926 – via www.bmj.com.
- ^ "Medically unexplained symptoms". nhs.uk. October 19, 2017.
- ^ Löwe B, Toussaint A, Rosmalen JG, Huang WL, Burton C, Weigel A, et al. (June 15, 2024). "Persistent physical symptoms: definition, genesis, and management". The Lancet. 403 (10444): 2649–2662. doi:10.1016/S0140-6736(24)00623-8. PMID 38879263 – via www.thelancet.com.
- ^ Fink P, Schröder A (May 2010). "One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders". Journal of Psychosomatic Research. 68 (5): 415–426. doi:10.1016/j.jpsychores.2010.02.004. PMID 20403500.
- ^ Lacourt T, Houtveen J, van Doornen L (January 2013). ""Functional somatic syndromes, one or many?" An answer by cluster analysis". Journal of Psychosomatic Research. 74 (1): 6–11. doi:10.1016/j.jpsychores.2012.09.013. PMID 23272982.
- ^ Wessely S, White PD (August 2004). "There is only one functional somatic syndrome". The British Journal of Psychiatry. 185 (2): 95–96. doi:10.1192/bjp.185.2.95. PMID 15286058.
- ^ Teodoro T, Oliveira R (October 2023). "The conceptual field of medically unexplained symptoms and persistent somatic symptoms". CNS Spectrums. 28 (5): 526–527. doi:10.1017/S1092852922001031. hdl:10362/147363. PMID 36321347. S2CID 253256995.
- ^ Donnachie E, Schneider A, Enck P (June 17, 2020). "Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data". Scientific Reports. 10 (1): 9810. Bibcode:2020NatSR..10.9810D. doi:10.1038/s41598-020-66685-4. PMC 7299983. PMID 32555301.
- ^ a b c d e f g h i "2.2 The Putative Disappearance of Somatic Manifestations of Hysteria", From Photography to fMRI, transcript Verlag, pp. 219–237, 2022-12-31, doi:10.1515/9783839461761-009, ISBN 978-3-8394-6176-1, retrieved 2024-05-15,
In the late 1990s, it became a matter of heated debate if hysteria's nosological successors were conceptually and diagnostically distinguishable from a range of possibly related clinical conditions that were equally characterised by the lack of any demonstrable physical abnormality. Jointly referred to as functional somatic syndromes, these conditions include multiple chemical sensitivity, sick building syndrome, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, chronic whiplash, chronic Lyme disease, the Gulf War syndrome, food allergies, hypoglycaemia. To this date, the delineation between present-day forms of hysteria and other functional somatic syndromes remains unresolved.
- ^ Afari N, Ahumada SM, Wright LJ, Mostoufi S, Golnari G, Reis V, et al. (January 2014). "Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis". Psychosomatic Medicine. 76 (1): 2–11. doi:10.1097/PSY.0000000000000010. PMC 3894419. PMID 24336429.
- ^ Mayou R, Farmer A (August 2002). "ABC of psychological medicine: Functional somatic symptoms and syndromes". BMJ. 325 (7358): 265–268. doi:10.1136/bmj.325.7358.265. PMC 1123778. PMID 12153926.
- ^ Häuser W, Kosseva M, Üceyler N, Klose P, Sommer C (June 2011). "Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis". Arthritis Care & Research. 63 (6): 808–820. doi:10.1002/acr.20328. PMID 20722042.
- ^ Natelson BH, Lin JS, Lange G, Khan S, Stegner A, Unger ER (2019-11-17). "The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome". Annals of Medicine. 51 (7–8): 371–378. doi:10.1080/07853890.2019.1683601. PMC 7877877. PMID 31642345.
- ^ Thoma M, Froehlich L, Hattesohl DB, Quante S, Jason LA, Scheibenbogen C (December 2023). "Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients". Medicina. 60 (1): 83. doi:10.3390/medicina60010083. PMC 10819994. PMID 38256344.
- ^ Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Board on the Health of Select Populations, Institute of Medicine (2015-03-16). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, D.C.: National Academies Press. doi:10.17226/19012. ISBN 978-0-309-31689-7. PMID 25695122.
- ^ "NIH study offers new clues into the causes of post-infectious ME/CFS". National Institutes of Health (NIH). 2024-02-20. Retrieved 2024-04-19.
- ^ Petersen MW, Schröder A, Jørgensen T, Ørnbøl E, Dantoft TM, Eliasen M, et al. (July 1, 2020). "Prevalence of functional somatic syndromes and bodily distress syndrome in the Danish population: the DanFunD study". Scandinavian Journal of Public Health. 48 (5): 567–576. doi:10.1177/1403494819868592. PMID 31409218 – via PubMed.
- ^ Fischer S, Gaab J, Ehlert U, Nater UM (June 1, 2013). "Prevalence, overlap, and predictors of functional somatic syndromes in a student sample". International Journal of Behavioral Medicine. 20 (2): 184–193. doi:10.1007/s12529-012-9266-x. PMID 23055025 – via PubMed.
- ^ Åkerblom S, Perrin S, Rivano Fischer M, McCracken LM (April 2017). "The Impact of PTSD on Functioning in Patients Seeking Treatment for Chronic Pain and Validation of the Posttraumatic Diagnostic Scale". International Journal of Behavioral Medicine. 24 (2): 249–259. doi:10.1007/s12529-017-9641-8. PMC 5344943. PMID 28194719.
- ^ Yavne Y, Amital D, Watad A, Tiosano S, Amital H (August 2018). "A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia". Seminars in Arthritis and Rheumatism. 48 (1): 121–133. doi:10.1016/j.semarthrit.2017.12.011. PMID 29428291. S2CID 205143853.
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