Functional somatic syndromes: one or many?

Wessely, S; Nimnuan, C; Sharpe, M

doi:10.1016/s0140-6736(98)08320-2

Cited by 1,211Psychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome ResearchGastrointestinal motility and disorders

Functional somatic syndromes: one or many?

Wessely, S, Nimnuan, C, Sharpe, M·1999·The Lancet

DOI 10.1016/s0140-6736(98)08320-2

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Abstract

We review the concept and importance of functional somatic symptoms and syndromes such as irritable bowel syndrome and chronic fatigue syndrome. On the basis of a literature review, we conclude that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences. Similarities are apparent in case definition, reported symptoms, and in non-symptom association such as patients' sex, outlook, and response to treatment. We conclude that the existing definitions of these syndromes in terms of specific symptoms is of limited value; instead we believe a dimensional classification is likely to be more productive.

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Patients frequently receive medical specialty-specific syndrome diagnoses such as fibromyalgia, chronic widespread pain, chronic fatigue syndrome, and irritable bowel syndrome.
“In the healthcare system, patients frequently receive medical specialty-specific syndrome diagnoses (FSS) such as fibromyalgia, chronic widespread pain, chronic fatigue syndrome, and irritable bowel syndrome [6,7].”
From Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial (2023) · cites this paper as [6]

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Pharmacological interventions for somatoform disorders in adults
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Symptoms and the body: taking the inferential leap
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A Review of the Evidence for Overlap among Unexplained Clinical Conditions
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Somatoform Disorders: Time for a New Approach in DSM-V
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Risk factors for more severe regional musculoskeletal symptoms: A two‐year prospective study of a general working population
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Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome
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Neuroimaging of the brain–gut axis: From basic understanding to treatment of functional GI disorders
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The Association of Depression and Anxiety with Pain: A Study from NESDA
de Heer, E. W., Gerrits, M. M. J. G., Beekman, A. T. F., Dekker, J., van Marwijk, H. W. J., de Waal, M. W. M., Spinhoven, P., Penninx, B. W. J. H., & van der Feltz-Cornelis, C. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0106907 · Cited by 363 · see citing works
The Association Between Anxiety, Depression, and Somatic Symptoms in a Large Population: The HUNT-II Study
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Fibromyalgia: an overview
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One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders
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The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?
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Management of functional somatic syndromes and bodily distress
Henningsen, P., Zipfel, S., Sattel, H., & Creed, F. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000484413 · Cited by 335 · see citing works
The Neuroendocrinology of Chronic Fatigue Syndrome
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Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients
Fink, P., Toft, T., Hansen, M. S., Ørnbøl, E., & Olesen, F. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31802e46eb · Cited by 314 · see citing works
Irritable bowel syndrome: a little understood organic bowel disease?
Talley, N. J., & Spiller, R. E. (2002) · The Lancet · doi:10.1016/s0140-6736(02)09712-x · Cited by 304 · see citing works
Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study
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Functional somatic disorders: discussion paper for a new common classification for research and clinical use
on behalf of the EURONET-SOMA Group, Burton, C., Fink, P., Henningsen, P., Löwe, B., & Rief, W. (2020) · BMC Medicine · doi:10.1186/s12916-020-1505-4 · Cited by 292 · see citing works
Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease'
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Persistent physical symptoms: definition, genesis, and management
Löwe, B., Toussaint, A., Rosmalen, J. G. M., Huang, W.-L., Burton, C., Weigel, A., Levenson, J. L., & Henningsen, P. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00623-8 · Cited by 280 · see citing works
How many functional somatic syndromes?
Nimnuan, C., Rabe-Hesketh, S., Wessely, S., & Hotopf, M. (2001) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00224-0 · Cited by 269 · see citing works
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Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS).
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Visceral pain
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Irritable bowel syndrome and surgery: A multivariable analysis☆
Longstreth, G. F., & Yao, J. F. (2004) · Gastroenterology · doi:10.1053/j.gastro.2004.02.020 · Cited by 248 · see citing works
Fibromyalgia: A Stress Disorder?
van Houdenhove, B., & Egle, U. (2004) · Psychotherapy and Psychosomatics · doi:10.1159/000078843 · Cited by 219 · see citing works
Somatic symptom disorder: an important change in DSM
Dimsdale, J. E., Creed, F., Escobar, J., Sharpe, M., Wulsin, L., Barsky, A., Lee, S., Irwin, M. R., & Levenson, J. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.06.033 · Cited by 239 · see citing works
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Impaired cognitive performance in patients with chronic burnout syndrome
Sandström, A., Rhodin, I. N., Lundberg, M., Olsson, T., & Nyberg, L. H. (2004) · Biological Psychology · doi:10.1016/j.biopsycho.2004.08.003 · Cited by 242 · see citing works
A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review
Teodoro, T., Edwards, M. J., & Isaacs, J. D. (2018) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317823 · Cited by 241 · see citing works
A population-based twin study of functional somatic syndromes
Kato, K., Sullivan, P. F., Evengård, B., & Pedersen, N. L. (2009) · Psychological Medicine · doi:10.1017/s0033291708003784 · Cited by 237 · see citing works
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The Association or Otherwise of the Functional Somatic Syndromes
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Self-citation
There is only one functional somatic syndrome
Wessely, S. C., & White, P. D. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.185.2.95 · Cited by 193 · see citing works
Self-citation
IN DEBATE There is only one functional somatic syndrome*
Wessely, S. C., & White, P. D. (2016)
Self-citation
A Tight-Knit Family of Syndromes
Manu, P. (2020) · Routledge eBooks · doi:10.4324/9781003063773-4
Functional somatic syndromes
Sharpe, M., Nimnuan, C., & Wessely, S. C. (1999) · The Lancet · doi:10.1016/s0140-6736(05)76816-1 · Cited by 19 · see citing works
Self-citation

Authors: Wessely, S., Nimnuan, C., & Sharpe, M.
Affiliations: Royal Edinburgh Hospital (GB)
ORCID: Wessely, S
Sharpe, M
Venue: The Lancet
Publisher: Elsevier BV
Published: 1999-09
Volume: 354
Issue: 9182
Pages: 936-939
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(98)08320-2
OpenAlex: W2137698397
Cited by: 1,211
References: 153
Citations by year: 2026: 20 · 2025: 29 · 2024: 36 · 2023: 26 · 2022: 24 · 2021: 36 · 2020: 37 · 2019: 36 · 2018: 36 · 2017: 53 · 2016: 38 · 2015: 53 · 2014: 36 · 2013: 38 · 2012: 49
FWCI: 5.33
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords: functional somatic syndromes, irritable bowel syndrome, chronic fatigue syndrome, dimensional classification, case definition, symptom overlap, sex differences, treatment response
MeSH terms: Colonic Diseases, Functional, Combined Modality Therapy, Humans, Patient Care Team, Prognosis, Sick Role, Somatoform Disorders, Fatigue Syndrome, Chronic

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Functional somatic syndromes: one or many?

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