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The Association or Otherwise of the Functional Somatic Syndromes

From King's College London (R.A.A.K., S.C.W.), Department of Psychological Medicine, Institute of Psychiatry, London, UK; Université Paris Descartes (J.P.L.), Faculté de Pharmacie, Neuropsychopharmacologie des Addictions, CNRS, et Université Paris 7, France; INSERM (J.P.L.), Paris, France; Assistance Publique-Hôpitaux de Paris (J.P.L.), Hôpital Fernand Widal, Service de Psychiatrie, Paris, France.

Address correspondence and reprint requests to Simon Wessely, Institute of Psychiatry, Department of Psychological Medicine, P062, Weston Education Centre, London SE5 9RJ, UK. E-mail: s.wessely{at}iop.kcl.ac.uk

ABSTRACT

Objective: To review the evidence for overlap in the phenomenology of the Functional Somatic Syndromes (FSS). The FSS show considerable comorbidity, leading some to suggest they may be aspects of the same disorder.

Methods: We conducted a selective review of peer-reviewed articles on the co-occurrence of FSS symptoms and diagnoses.

Results: Considerable evidence of overlap was found at the level of symptoms, diagnostic criteria, and clinical diagnoses made.

Conclusions: Phenomenological commonalities support a close relationship between the FSS, although differences remain in other domains. Whether the FSS may best be considered the same or different will depend on the pragmatics of diagnosis.

Key Words: diagnosis • chronic fatigue syndrome • irritable bowel syndrome • fibromyalgia • phenomenology • comorbidity

Abbreviations: IBS = irritable bowel syndrome; FSS = functional somatic syndromes; DSM = Diagnostic and Statistical Manual; CFS = chronic fatigue syndrome; FM = fibromyalgia; OR = odds ratio.

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