Published 25 August 2009, doi:10.1136/bmj.b3424
Cite this as: BMJ 2009;339:b3424

Letters

Painful bladder syndrome

Role of psychological factors

The first 150 words of the full text of this article appear below.

In their review of the management of painful bladder syndrome Marinkovic and colleagues highlight the syndrome as a common and debilitating set of urological symptoms lacking explanatory cystoscopic abnormalities.1 They document its strong association with sexual abuse, fibromyalgia, chronic fatigue syndrome, and, strikingly, a 100-fold increased risk of irritable bowel syndrome—all of which have good evidence for the role, at least in part, of psychological factors in their aetiology or maintenance. Evidence also suggests high rates of psychological disorder, such as depression and anxiety disorders, in the painful bladder syndrome.2

What are we to make of these associations? Psychological factors are likely to contribute to the aetiology. Such disorders, where physical pathology cannot fully account for symptoms, are known as "medically unexplained" or "functional" (somatic) syndromes. They are common to all specialties of medicine, and they may be the same underlying disorder manifesting itself in different bodily systems.3

Despite drawing . . . [Full text of this article]

Timothy R Nicholson, honorary SpR in psychiatry1, Richard A Kanaan, honorary consultant psychiatrist1, Simon Wessely, head1

1 Department of Psychological Medicine, Institute of Psychiatry, London SE5 8AF

timothy.nicholson@kcl.ac.uk


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