Functional somatic syndrome

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Functional somatic syndrome
Specialty Psychiatry

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar.[ citation needed ] It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, [1] lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. [2] General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. [3] Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease. [4] [5] [6]

Contents

The currently identified class of functional somatic syndromes present as a complex enigma within the medical community; they are highly prevalent, but little is known about the etiology of these conditions. A majority of patients presenting with persistent, widespread somatic complaints have no identifiable organic cause. Biological markers for the FSS diagnoses are non-existent, making the categorization difficult; there is currently much debate regarding whether the FSS diagnoses represent separate conditions or one overarching diagnosis. [1] 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%. [7]

While FSS diagnoses are relatively common within the general community, they are significantly more common among patients presenting with comorbid psychopathology; approximately one third of patients presenting with an FM diagnosis also meet criteria for posttraumatic stress disorder (PTSD). [8] Similarly, 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. [9] Aside from the physiological symptoms of FSS such as sleep disturbances, chronic pain and general fatigue, certain psychological symptoms are also associated with most FSSs, such as anxiety, depression and panic disorder.

Signs and symptoms

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 [10] [11] or into one general functional somatic disorder given the finding of correlations between symptoms and underlying etiologies. [12] [13]

Examples

Various conditions have been named as examples of this, including:

Potential causes

Biological factors

One commonly cited hypothesis in the literature implicates the hypothalamic–pituitary–adrenal axis (HPA axis) and cortisol secretion in the manifestation of somatic symptoms following trauma. [15] 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. [16] 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. [17] For example, fibromyalgia is characterized as a stress response disorder; similar to trauma, patients with fibromyalgia demonstrate a susceptibility to neuroendocrine dysfunctions. Fibromyalgia patients statistically exhibit atypical patterns of daily cortisol secretion, as well as significantly low urine cortisol levels. [15]

Psychological factors

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. [18] Further, childhood trauma such as sexual abuse or maltreatment can indicate an increased propensity for later somatic syndrome onset. Current theories propose an "attentional bias" as the psychological mechanism by which trauma and somatic symptoms are tied. [19] [20] 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. [20] 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. [19] 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. [21] 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. [22]

Diagnosis

Diagnosis of a FSS is usually conducted in a "rule-out" method, where physicians rule out other rheumatology disorders with existing biomarkers prior to arriving at a FSS diagnosis.

Treatment

Due to the underlying psychological component of functional somatic syndromes, therapeutic approaches such as cognitive behavioral therapy (CBT) are common treatments. Multiple antidepressants have also shown to be effective for FSS diagnoses that include chronic pain.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Irritable bowel syndrome</span> Functional gastrointestinal disorder

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements. These symptoms may occur over a long time, sometimes for years. IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome which commonly presents as chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and certain infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome".

<span class="mw-page-title-main">Somatization disorder</span> Mental disorder consisting of clinically significant somatic symptoms

Somatization disorder was a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.

Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome, is a name given by John E. Sarno to what he claimed was a condition of psychogenic musculoskeletal and nerve symptoms, most notably back pain. Sarno described TMS in four books, and stated that the condition may be involved in other pain disorders as well. The treatment protocol for TMS includes education, writing about emotional issues, resumption of a normal lifestyle and, for some patients, support meetings and/or psychotherapy.

Functional abdominal pain syndrome (FAPS), chronic functional abdominal pain (CFAP), or centrally mediated abdominal pain syndrome (CMAP) is a pain syndrome of the abdomen, that has been present for at least six months, is not well connected to gastrointestinal function, and is accompanied by some loss of everyday activities. The discomfort is persistent, near-constant, or regularly reoccurring. The absence of symptom association with food intake or defecation distinguishes functional abdominal pain syndrome from other functional gastrointestinal illnesses, such as irritable bowel syndrome (IBS) and functional dyspepsia.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

Functional constipation, known as chronic idiopathic constipation (CIC), is constipation that does not have a physical (anatomical) or physiological cause. It may have a neurological, psychological or psychosomatic cause. A person with functional constipation may be healthy, yet has difficulty defecating.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

A functional symptom is a medical symptom with no known physical cause. In other words, there is no structural or pathologically defined disease to explain the symptom. The use of the term 'functional symptom' does not assume psychogenesis, only that the body is not functioning as expected. Functional symptoms are increasingly viewed within a framework in which 'biological, psychological, interpersonal and healthcare factors' should all be considered to be relevant for determining the aetiology and treatment plans.

Somatic psychology was introduced in the early 20th century by the Austrian psychiatrist and psychoanalyst Wilhelm Reich.

A wastebasket diagnosis or trashcan diagnosis is a vague diagnosis given to a patient or to medical records department for essentially non-medical reasons. It may be given when the patient has an obvious but unidentifiable medical problem, when a doctor wants to reassure an anxious patient about the doctor's belief in the existence of reported symptoms, when a patient pressures a doctor for a label, or when a doctor wants to facilitate bureaucratic approval of treatment. It differs from a diagnosis of exclusion in that a wastebasket diagnosis is a diagnostic label of doubtful value, whereas a diagnosis of exclusion is characterized by the diagnosis being arrived at indirectly. Unlike a vague wastebasket diagnosis, the diagnostic label arrived at through a process of exclusion may be precise, accurate, and helpful.

The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.

Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors, without evidence of physical injury or illness.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

<span class="mw-page-title-main">Myalgic encephalomyelitis/chronic fatigue syndrome</span> Chronic medical condition


Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience delayed worsening of the illness after minor physical or mental activity, which is the hallmark symptom of the illness. Other symptoms are a greatly reduced ability to do tasks that were previously easy, severe fatigue that does not improve much with rest, and sleep disturbances. Further common symptoms include dizziness or nausea when sitting or standing, along with memory and concentration issues and pain.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

References

  1. 1 2 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, D.C.: National Academies Press. 2015-03-16. doi:10.17226/19012. ISBN   978-0-309-31689-7.
  6. ↑ "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.
  7. ↑ 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.
  8. ↑ Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, et al. (February 2021). "The Prevalence of Psychiatric and Chronic Pain Comorbidities in Fibromyalgia: an ACTTION systematic review". Seminars in Arthritis and Rheumatism. 51 (1): 166–174. doi:10.1016/j.semarthrit.2020.10.006. PMID   33383293. S2CID   229948862.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. 1 2 3 4 5 6 7 8 9 10 "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.
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  17. ↑ Weber DA, Reynolds CR (June 2004). "Clinical perspectives on neurobiological effects of psychological trauma". Neuropsychology Review. 14 (2): 115–129. doi:10.1023/b:nerv.0000028082.13778.14. PMID   15264712. S2CID   24172922.
  18. ↑ 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.
  19. 1 2 Golding JM (March 1994). "Sexual assault history and physical health in randomly selected Los Angeles women". Health Psychology. 13 (2): 130–138. doi:10.1037/0278-6133.13.2.130. PMID   8020456.
  20. 1 2 Carleton RN, Duranceau S, McMillan KA, Asmundson GJ (April 2018). "Trauma, Pain, and Psychological Distress". Journal of Psychophysiology. 32 (2): 75–84. doi:10.1027/0269-8803/a000184. ISSN   0269-8803. S2CID   151333609.
  21. ↑ Pennebaker JW (1982). The Psychology of Physical Symptoms. doi:10.1007/978-1-4613-8196-9. ISBN   978-1-4613-8198-3.
  22. ↑ Antony MM, Brown TA, Craske MG, Barlow DH, Mitchell WB, Meadows EA (September 1995). "Accuracy of heartbeat perception in panic disorder, social phobia, and nonanxious subjects". Journal of Anxiety Disorders. 9 (5): 355–371. doi:10.1016/0887-6185(95)00017-i. ISSN   0887-6185.
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