Med Hypotheses. 2003 Oct;61(4):419-30.
Are syndromes in environmental medicine variants
of somatoform disorders?
Wiesmuller GA, Ebel H, Hornberg C, Kwan O, Friel J.
Institute of Hygiene and Environmental Medicine,
University Hospital Aachen, Aachen, Germany.
To date, relatively little is known about the
etiology, pathophysiology, diagnosis, therapy,
prevention and prognosis of environment-related
syndromes like multiple chemical sensitivity
(MCS), idiopathic environmental intolerance (IEI),
sick building syndrome (SBS), chronic fatigue
syndrome (CFS), candida syndrome (CS) and
burnout syndrome (BS). Part of the reason is that
these syndromes have not been clearly defined
and classified in scientific categories distinct from
each other, and that they show clinical similarities
to classified somatoform disorders.
Furthermore, there are at least three possible
explanations for the existence of these syndromes:
(1) The syndromes may result from the interaction
of environmental factors, individual
susceptibility and psychological factors (i.e., how
they are perceived and seen by the patient); (2)
they may reflect socially and culturally accepted
methods of expressing distress; and/or (3) they
may be iatrogenic. Despite all the uncertainties
in evaluation of environmental syndromes,
physicians have the duty to take the affected
person's problems seriously. A comprehensive
systematic classification which better accounts
for these complex clinical manifestations is long
overdue. Until these syndromes are well defined,
the terms used for them should definitely not be
applied to connote a specific disease process.