Elsevier

The Lancet

Volume 354, Issue 9182, 11 September 1999, Pages 936-939
The Lancet

Review
Functional somatic syndromes: one or many?

https://doi.org/10.1016/S0140-6736(98)08320-2Get rights and content

Summary

We review the concept and importance of functional somatic symptoms and syndromes such as irritable bowel syndrome and chronic fatigue syndrome. On the basis of a literature review, we conclude that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences. Similarities are apparent in case definition, reported symptoms, and in non-symptom association such as patients' sex, outlook, and response to treatment. We conclude that the existing definitions of these syndromes in terms of specific symptoms is of limited value; instead we believe a dimensional classification is likely to be more productive.

Section snippets

Are there specific functional somatic syndromes?

Each medical specialty has defined its own syndrome or syndromes in terms of symptoms that relate to their organ of interest. In addition, other more controversial syndromes such as multiple chemical sensitivity and repetitive strain injury have been proposed but less widely accepted. Each syndrome tends to be regarded as a unique diagnostic entity with its own special characteristics. Furthermore, many of these syndromes are dignified by their own formal case definition and body of research

Implications of the overlap in functional somatic syndromes

If we accept that the specific functional somatic syndromes as conventionally defined have much in common, what are the implications?

Classification—The main implication for classification is that the current practice of regarding patients with diagnoses of different functional somatic syndromes as having clinically significant differences is questionable. Rather, such patients may have similar conditions or variants of a general functional somatic syndrome. Do we have a more meaningful way to

Conclusion

Functional somatic symptoms and syndromes are a major health issue. They are common and may be persistent, disabling, and costly. Most of the current literature pertains to specific syndromes defined by medical subspecialties. We have put forward the hypothesis that the acceptance of distinct syndromes as defined in the medical literature should be challenged. We contend that the patients so defined actually have much in common. A review of the published evidence largely supports our

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