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Feeling Bad in More Ways than One: Comorbidity Patterns of Medically Unexplained and Psychiatric Conditions

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Abstract

Background

Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder.

Objective

To examine interrelationships among these 9 conditions.

Design

Using data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships.

Participants

3,982 twins from the University of Washington Twin Registry.

Measurements

Twins self-reported a doctor’s diagnosis of the conditions.

Results

Comorbidity among these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status.

Conclusions

These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients.

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Acknowledgements

This research was supported by National Institutes of Health awards 5 U19 AI038429 (Buchwald) and R55AR051524 (Afari). Dr. Schur is funded by a National Institutes of Health Career Development Award K23 DK070826.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Ellen A. Schur MD & Dedra Buchwald MD

  2. Department of Psychiatry, University of California, San Diego & VA San Diego Healthcare System, San Diego, CA, USA

    Niloofar Afari PhD

  3. Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Helena Furberg PhD, Megan Olarte & Patrick F. Sullivan MD, FRANZCP

  4. Department of Epidemiology, University of Washington & Vietnam Era Twin Registry, Seattle, WA, USA

    Jack Goldberg PhD

  5. Harborview Medical Center, Box 359780, 325 Ninth Avenue, Seattle, WA, 98104, USA

    Ellen A. Schur MD

Authors
  1. Ellen A. Schur MD
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  2. Niloofar Afari PhD
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  3. Helena Furberg PhD
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  4. Megan Olarte
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  5. Jack Goldberg PhD
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  6. Patrick F. Sullivan MD, FRANZCP
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  7. Dedra Buchwald MD
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Corresponding author

Correspondence to Ellen A. Schur MD.

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Schur, E.A., Afari, N., Furberg, H. et al. Feeling Bad in More Ways than One: Comorbidity Patterns of Medically Unexplained and Psychiatric Conditions. J GEN INTERN MED 22, 818–821 (2007). https://doi.org/10.1007/s11606-007-0140-5

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  • DOI: https://doi.org/10.1007/s11606-007-0140-5

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