Andy
Retired committee member
No abstract, my bolding.
Introduction
Impairing functional somatic symptoms without explanatory physical pathological findings are common in adolescents with prevalence estimates of 4–10% depending on study population [1]. Suffering from functional somatic symptoms in adolescence often has high implications including school absenteeism, social withdrawal and low quality of life [2], with frequent comorbid anxiety and depression [3–5]. Furthermore, there is a considerable risk of continuity of symptoms into adulthood consequently leading to lower educational attainment and high healthcare costs [6–8].
A lack of international consensus on nomenclature for impairing functional somatic symptoms has entailed various diagnostic classifications including functional somatic syndromes (FSS) (e.g. fibromyalgia, irritable bowel syndrome, chronic fatigue (CFS) and idiopathic pain syndrome), somatoform disorders (ICD-10) and somatic symptom and related disorders (DSM-5). Generally, the diagnoses are based on adult descriptors and do not take developmental perspectives into account (e. g. higher prevalence of mono-symptomatic presentation in younger people) [1,9]. Furthermore, due to a large overlap in their symptomatology, there is an ongoing discussion as to whether the diagnostic concepts describe distinct entities or, rather, mirror medical subspecialisation [10,11]. This notion could also explain the findings in epidemiological studies in adults suggesting that FSS rarely occur in their pure form, i.e. without comorbidity with other FSS, even in the general population [12]. A recently introduced empirically supported diagnostic category of Bodily Distress Syndrome (BDS) encompasses the majority of FSS and somatoform disorders in adults [13,14]. The diagnosis describes four symptom groups (i.e. musculoskeletal, cardiopulmonary, gastrointestinal and general symptoms) and can be divided into a single- or multi-organ type dependent on number of symptom groups involved [15]. Although the diagnostic category of BDS is not empirically founded in youth, equivalent functional somatic symptom clusters have been reported based on factor analyses on data from youth-orientated questionnaires, i.e. clusters with pain, gastrointestinal symptoms, cardiopulmonary symptoms and general symptoms, respectively [16,17].
Symptom profiles in adult FSS suggest that patients experience the same symptoms as individuals in the general population but with higher prevalence and symptom load [15]. Furthermore, psychological characteristics of adult patients with FSS have been reported, including maladaptive illness perception such as monocausal symptom attribution and expectations of long symptom duration [18] and higher degree of illness worry [19]. In addition, the disruption of secure attachment (i.e. the ability to form ‘lasting psychological connectedness between human beings’ developed through the early interaction with caregivers [20]) has been proposed as both a vulnerability and maintaining factor for FSS through maladaptive emotion regulation and symptom coping and a more easily and strongly activated stress response [21–23]. Thus, in adults with FSS attachment insecurity has been associated with implications on illness-related behaviour including higher health care seeking [24–27].
Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399921000751
Introduction
Impairing functional somatic symptoms without explanatory physical pathological findings are common in adolescents with prevalence estimates of 4–10% depending on study population [1]. Suffering from functional somatic symptoms in adolescence often has high implications including school absenteeism, social withdrawal and low quality of life [2], with frequent comorbid anxiety and depression [3–5]. Furthermore, there is a considerable risk of continuity of symptoms into adulthood consequently leading to lower educational attainment and high healthcare costs [6–8].
A lack of international consensus on nomenclature for impairing functional somatic symptoms has entailed various diagnostic classifications including functional somatic syndromes (FSS) (e.g. fibromyalgia, irritable bowel syndrome, chronic fatigue (CFS) and idiopathic pain syndrome), somatoform disorders (ICD-10) and somatic symptom and related disorders (DSM-5). Generally, the diagnoses are based on adult descriptors and do not take developmental perspectives into account (e. g. higher prevalence of mono-symptomatic presentation in younger people) [1,9]. Furthermore, due to a large overlap in their symptomatology, there is an ongoing discussion as to whether the diagnostic concepts describe distinct entities or, rather, mirror medical subspecialisation [10,11]. This notion could also explain the findings in epidemiological studies in adults suggesting that FSS rarely occur in their pure form, i.e. without comorbidity with other FSS, even in the general population [12]. A recently introduced empirically supported diagnostic category of Bodily Distress Syndrome (BDS) encompasses the majority of FSS and somatoform disorders in adults [13,14]. The diagnosis describes four symptom groups (i.e. musculoskeletal, cardiopulmonary, gastrointestinal and general symptoms) and can be divided into a single- or multi-organ type dependent on number of symptom groups involved [15]. Although the diagnostic category of BDS is not empirically founded in youth, equivalent functional somatic symptom clusters have been reported based on factor analyses on data from youth-orientated questionnaires, i.e. clusters with pain, gastrointestinal symptoms, cardiopulmonary symptoms and general symptoms, respectively [16,17].
Symptom profiles in adult FSS suggest that patients experience the same symptoms as individuals in the general population but with higher prevalence and symptom load [15]. Furthermore, psychological characteristics of adult patients with FSS have been reported, including maladaptive illness perception such as monocausal symptom attribution and expectations of long symptom duration [18] and higher degree of illness worry [19]. In addition, the disruption of secure attachment (i.e. the ability to form ‘lasting psychological connectedness between human beings’ developed through the early interaction with caregivers [20]) has been proposed as both a vulnerability and maintaining factor for FSS through maladaptive emotion regulation and symptom coping and a more easily and strongly activated stress response [21–23]. Thus, in adults with FSS attachment insecurity has been associated with implications on illness-related behaviour including higher health care seeking [24–27].
Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399921000751
