Idiopathic Environmental Intolerance: A Comprehensive Model

Van den Bergh, Omer; Brown, Richard J.; Petersen, Sibylle; Witthöft, Michael

doi:10.1177/2167702617693327

Cited by 121Psychosomatic Disorders and Their TreatmentsPain Management and Placebo EffectNoise Effects and Management

Idiopathic Environmental Intolerance: A Comprehensive Model

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Van den Bergh, Omer, Brown, Richard J., Petersen, Sibylle, Witthöft, Michael·2017·Clinical Psychological Science

DOI 10.1177/2167702617693327

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Abstract

Idiopathic environmental intolerance refers to a group of poorly understood health conditions characterized by heterogeneous somatic symptoms that occur in response to environmental triggers, but for which no physiological causes can be found. We focus on three varieties, namely symptoms attributed to (a) chemical substances, (b) electromagnetic fields, and (c) infrasound and vibroacoustic sources. As no clear link with organ pathology or dysfunction has been established so far, we review critical evidence about alternative causal mechanisms as a platform for a novel unifying model of these conditions. There is consistent evidence that expectancy and nocebo mechanisms are critically involved. Using recent predictive coding models of brain functioning, we describe a comprehensive new model to explain how symptoms come about and become linked to specific environmental cues. This new model integrates phenomenally different pathologies, suggests testable new hypotheses, and specifies implications for treatment.

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Disabling PPS, manifesting as building-related environmental intolerance, has a biopsychosocial nature, emphasizing symptom perception, awareness, and interpretation rather than organic or toxicological causes.
“Research has revealed that disabling PPS, manifesting as building-related environmental intolerance, has a biopsychosocial nature, emphasizing symptom perception, awareness, and interpretation rather than organic or toxicological causes [12, 13, 15].”
From Work Ability and Functioning Among Individuals with Persistent Indoor Environment-Related Symptoms or Chronic Fatigue: Nine-Month Follow-Up of a Web-Based Randomized Controlled Trial. (2026) · cites this paper as [12]
The Biopsychosocial mechanisms section links environmental-intolerance symptoms to exposure awareness and expectations, and the Summary says compelling evidence for an underlying disease process or physiological trigger–symptom association is absent in the conditions reviewed. But on p. 5 the authors say Sick Building Syndrome is not discussed directly, although they believe their model applies to it. The Sources of Symptoms in IEI section also allows that symptoms can begin with a toxic exposure, so the claim’s building-specific and categorical ‘rather than organic or toxicological causes’ wording goes beyond the source. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Excessive central nervous system reactivity and related illness worry (IW) may be seen as core features of PPS and they often overlap.
“Excessive central nervous system reactivity and related illness worry (IW) may be seen as core features of PPS and they often overlap [12, 16].”
From Work Ability and Functioning Among Individuals with Persistent Indoor Environment-Related Symptoms or Chronic Fatigue: Nine-Month Follow-Up of a Web-Based Randomized Controlled Trial. (2026) · cites this paper as [12]
In “A common mechanism?” (page unavailable), the paper describes enhanced responsivity as central to the forms of idiopathic environmental intolerance it discusses. In “Providing Alternative Priors for Low Precise Prediction Errors” (page unavailable), it says illness worry may chronically activate stress-response systems and symptom-related mental models. It does not establish these as core features of PPS generally or show that nervous-system reactivity and illness worry often overlap. (LLM, conf=0.82)
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Postlude
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Postlude
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The Fear of Smell
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Ambient Scenting, Architecture, and the City
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Interlude
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Sublime Stenches
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Prelude
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Toward a Total Work of Art
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Perfume between Art and Design
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An Invitation to Discovery
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Overview
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Interlude
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The Dialectic of Deodorization
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Idiopathic Environmental Intolerance: A Treatment Model
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Idiopathic environmental intolerances
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Psychological models of development of idiopathic environmental intolerances: Evidence from longitudinal population-based dataPreprint
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Idiopathic Environmental Intolerance
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Authors: Van den Bergh, O., Brown, R. J., Petersen, S., & Witthöft, M.
Affiliations: Health Psychology, University of Leuven, Belgium
Greater Manchester Mental Health NHS Foundation Trust (GB)
University of Luxembourg (LU)
Johannes Gutenberg University Mainz (DE)
ORCID: Brown, Richard J.
Petersen, Sibylle
Witthöft, Michael
Venue: Clinical Psychological Science
Publisher: SAGE Publications
Published: 2017-05
Volume: 5
Issue: 3
Pages: 551-567
ISSN: 2167-7026 (ISSN-L)
2167-7034
DOI: 10.1177/2167702617693327
OpenAlex: W2593754217
Cited by: 121
References: 127
Citations by year: 2026: 7 · 2025: 10 · 2024: 11 · 2023: 6 · 2022: 11 · 2021: 8 · 2020: 47 · 2019: 8 · 2018: 6 · 2017: 7
FWCI: 15.35
Type: journal article
Language: en
Open access: green
orbilu.uni.lu
Licence: other-oa
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Psychological Science (publishedVersion)
Open Repository and Bibliography (University of Luxembourg) (submittedVersion, other-oa)
Research Explorer (The University of Manchester) (submittedVersion, other-oa)
Lirias (submittedVersion)
Funders: Fonds National de la Recherche Luxembourg
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
Keywords: multiple chemical sensitivity, electromagnetic hypersensitivity, infrasound, somatic symptoms, environmental triggers, expectancy, nocebo, predictive coding, causal mechanisms, therapeutic implications

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Idiopathic Environmental Intolerance: A Comprehensive Model

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