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Am Fam Physician. 1999;60(5):1551

Functional somatic syndrome refers to several related syndromes characterized more by symptoms, suffering and disability than by disease-specific abnormalities of structure or function. Physicians frequently encounter patients with disabling, medically unexplained symptoms, many of whom have already given themselves a diagnostic label for their complaints. These patients resist information that contradicts attribution of their symptoms to a specific disease. The functional somatic syndromes include entities such as multiple chemical hypersensitivity, sick building syndrome, repetition stress injury, chronic whiplash, chronic Lyme disease, the side effects of silicone breast implants, candidiasis sensitivity, Gulf War syndrome, mitral valve prolapse and hypoglycemia.

Barsky and Borus reviewed the medical literature to prepare this summary. Functional somatic syndromes are not new, but today's victims seem to be less relieved by negative findings on medical evaluation and less responsive to physician explanation and reassurance. This shift may be caused by a decline in physician authority, an increasing anti-science attitude, exaggeration by the media, and political and economic reinforcement of these syndromes as real medical entities.

The various functional syndromes are similar in that they are diffuse, nonspecific, ambiguous and prevalent in healthy, nonpatient populations. Symptoms include common complaints such as fatigue, headache, joint pains, weakness, memory problems, anxiety and palpitations. These patients have a higher incidence of psychiatric disorders, particularly anxiety, depressive and somatoform disorders. Psychosocial factors that amplify symptoms include: (1) the belief that one is sick, (2) the strong role of suggestion, (3) the secondary gain of the sick role and (4) stress.

Medical management of functional somatic syndromes is outlined in the accompanying table. Traditional psychotherapy and psychotropic medications may be indicated in the minority of patients with a specific psychiatric problem.

Rule out diagnosable medical disease.
Search for psychiatric disorders.
Build a collaborative alliance with the patient.
Make restoration of function the treatment goal.
Provide limited reassurance.
Prescribe cognitive-behavioral therapy when appropriate.

The authors conclude that functional somatic syndromes are common causes of suffering and that more recognition of the psychologic and sociocultural factors involved in these syndromes is necessary. This biopsychosocial model needs to be equally applied to these conditions by the medical profession, the public and the media.

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