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.