Review
Somatic Symptom Disorders Without Known Physical Causes: One Disease with Many Names?

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Abstract

Patients complaining of pain or fatigue in the absence of known physical diseases constitute a high percentage of those seeking general medical care. Depending upon the type of physician/specialist consulted, those individuals may receive disease labels that range from an implied psychological origin such as somatoform or psychosomatic disease, or to a presumed physical disease such as fibromyalgia. Although all these conditions are regularly associated with fatigue, we have provided a new label suggesting another disease category, “systemic exertion intolerance disease,” which replaces the previous “chronic fatigue syndrome.” All these conditions have common, overlapping features that usually consist of both fatigue and pain, and, in the absence of definitive objective confirmation, might be best classified under one heading such as somatic symptom disorder. Management of these disorders is challenging, but suggestions for proper identification and treatment are presented.

Section snippets

Psychiatric Nomenclature: Somatic Symptom Disorder

Formerly named “Somatoform Disorder,” this condition continues to be included within the categories of psychiatric disorders. In the latest Diagnostic and Statistical Manual of Mental Disorders, 5th edition1 handbook, it has been renamed somatic symptom disorder. Previous labels such as somatization disorder, hypochondriasis, and widespread pain disorder have been removed in favor of this more inclusive term, “somatic symptom disorder.” This new classification recognizes that mind and body

Fibromyalgia

As noted, the diagnosis of fibromyalgia suggests a physical origin, and this often leads to the referral of such patients—rightly or wrongly—to a rheumatologist. Although the major complaint in these patients is centered on pains, multiple additional symptoms are included in this disorder, and they seem to place the origin in the brain or central nervous system, with the suggested term of “central sensitization.”6, 7 In the case of fibromyalgia, we were first provided with the “objective” means

Chronic Fatigue Syndrome

One of the commonest complaints we hear as physicians is that of fatigue, which is quite prevalent in the general population. From surveys involving patients visiting family physicians, 28% reported fatigue.16 This symptom may signify a serious underlying organic disease, but it is far more often the result of psychological factors such as anxiety, depression, overwork, lack of adequate sleep, or simply boredom, stresses that may be caused by an unhappy marriage, work frustrations, or a myriad

Conclusions

Because of the similarity and tremendous overlap of symptoms among the various somatic conditions noted above, they all might best be categorized under one label, possibly somatic symptom disorder, or, alternatively, central sensitization disorder. Until we discover objective chemical or biopsy proof, little purpose is served by applying various labels that suggest differing underlying mechanisms, which often results in the referral of patients to fragmented specialty groups.

These patients may

Acknowledgment

The author is indebted to Edward R. Gabovitch, MD, rheumatologist, for providing valuable personal observations and insight concerning this important and challenging problem.

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    Conflict of Interest: None.

    Authorship: The author is solely responsible for writing this manuscript.

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