Recent Developments in the Understanding and Management of Functional Somatic Symptoms in Primary Care

Per Fink; Marianne Rosendal

Disclosures

Curr Opin Psychiatry. 2008;21(2):182-188. 

In This Article

Confusing Terminology

Somatic symptoms not attributable to any known conventionally defined disease have been given various names such as medically unexplained (physical) symptoms [MU(P)Ss], functional somatic (or physical) symptoms (FSSs), idiopathic symptoms, and somatoform symptoms.[5] In primary care, MUSs or MUPSs are the most commonly used terms. It seems unsatisfactory, however, to define a condition by something it is not, and doctors may be reluctant to use a term indicating that they do not know what is wrong with the patients. Furthermore, the term signifies that medicine includes only biomedicine. Although the term FSS may indicate a mental condition to doctors, it seems acceptable to patients.[6]

In psychiatric classifications, FSSs are classified as somatoform disorders or a few related diagnoses: neurasthenia and dissociative disorders in the International Classification of Diseases (ICD-10). The somatoform disorder diagnoses, however, are rarely used in primary care or in other nonpsychiatric specialties. Instead, medical specialties have introduced their own designations for the functional syndromes such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome etc.[2,3]

The terminology issue is not only a problem from a scientific point of view but also from a clinical one. In a Danish study,[7] GPs classified new health complaints as either physical disease or FSSs. The GPs' diagnostic ratings varied from 3% to 33% FSSs, and this variation could not be explained by differences in the patient populations. The GPs' recognition of the condition is a precondition for treatment, thus the large diagnostic variation may affect the management of patients. Furthermore, if a patient fulfils the diagnostic criteria for several diagnoses simultaneously due to massive overlap in condition definitions, the question is which diagnostic label should the GP use. A common language and theoretical framework for understanding FSSs and functional disorders across medical specialties are required and are a precondition for the further development of improved treatment.[2]

Improved diagnostic classification is also needed from a patient's perspective. Patients with functional disorders may find it difficult to have their illness acknowledged in the social security system, which may cause problems in getting disability benefits, for example.

We need valid and modern research and an evidence-based diagnostic system including unambiguous criteria and terminology for FSSs and functional disorders.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....