Excerpt
Somatic symptoms that cannot be readily explained by modern medicine are labeled as “functional” or “medically unexplained,” i.e., after thorough medical examination, no structural pathology and no proportional tissue abnormalities can be identified for these symptoms. Functional somatic syndromes (FSS) are defined by a constellation of functional or medically unexplained symptoms [
1]. Among the most prominent and prevalent FSS are chronic fatigue syndrome, irritable bowel syndrome, and fibromyalgia syndrome. But there are many more: chronic pelvic pain, low back pain, tension headache, noncardiac chest pain, multiple chemical sensitivity, the sick building syndrome, chronic whiplash syndrome, the Gulf War syndrome, and temporomandibular joint syndrome, just to name a few. Although a literature search on PubMed using the term “functional somatic syndromes” yields almost 1,000 hits (and there are many more when searching for single FSS, such as chronic fatigue syndrome), it is remarkable how little is known about those enigmatic conditions. For example, it is still a major challenge in the field of FSS (and medicine in general) to develop concepts of what “no structural pathology and no proportional tissue abnormalities” actually means; maybe modern medicine is just not yet adequately equipped with the technology needed in order to detect abnormalities that may fully explain symptoms of FSS? Maybe it is just a matter of time until a common medical explanation can be found for each FSS. One instantly thinks of “stress-related ulcers,” which had been thought of as expressions of an underlying psychosomatic process—but were ultimately found to be caused by a bacterium called
Helicobacter pylori. Although this finding does not exclude an interaction of psychological and biological processes in the manifestation of ulcers, it clearly shows that the matter of “medical explanation” is challenging. It is a very pragmatic question that asks whether it is at all relevant to distinguish between medically explained and medically unexplained symptoms, then. In the first paper of this special series, Klaus et al. convincingly argue that, from a clinical perspective, it is not relevant: both medically explained and medically unexplained symptoms result in comparable impairment and persist equally over time. A similar approach will be taken in the new edition of the classification manual of psychiatric conditions, the Diagnostic and Statistical Manual of Mental Disorders-V, in which the previously used term “somatoform,” i.e., medically unexplained, is going to be abandoned, mostly due to the reasoning that it does not matter clinically whether bodily symptoms may be medically explained or not, but whether symptoms are causing distress or not, and how patients are dealing with their symptoms. …
