Clinical Review ABC of psychological medicine

Functional somatic symptoms and syndromes

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7358.265 (Published 03 August 2002) Cite this as: BMJ 2002;325:265
  1. Richard Mayou,
  2. Andrew Farmer

    Concern about symptoms is a major reason for patients to seek medical help. Many of the somatic symptoms that they present with—such as pain, weakness, and fatigue—remain unexplained by identifiable disease even after extensive medical assessment. Several general terms have been used to describe this problem—somatisation, somatoform, abnormal illness behaviour, medically unexplained symptoms, and functional symptoms. We will use the term functional symptoms, which does not assume psychogenesis but only a disturbance in bodily functioning.

    Some common functional symptoms and syndromes

    • Muscle and joint pain (fibromyalgia)

    • Low back pain

    • Tension headache

    • Atypical facial pain

    • Chronic fatigue (myalgic encephalomyelitis)

    • Non-cardiac chest pain

    • Palpitation

    • Non-ulcer dyspepsia

    • Irritable bowel

    • Dizziness

    • Insomnia

    Classification of functional syndromes

    Most functional symptoms are transient, but a sizeable minority become persistent. Persistent symptoms are often multiple and disabling and may be described as functional syndromes. Although different medical and psychiatric classifications of functional syndromes exist, these are simply alternative ways of describing the same conditions.

    René Descartes, who formulated the philosophical principle of separation of brain and mind. This has led to continuing dualism—separation of body and mind—in Western medicine and difficulty in accepting the interaction of physical and psychological factors in aetiology

    Medical syndromes(such as fibromyalgia and chronic fatigue, chronic pain, and irritable bowel syndromes) highlight patterns of somatic symptoms, often in relation to particular bodily systems. Although they are useful in everyday medical practice, recent studies show there is substantial overlap between them.

    Psychiatric syndromes(such as anxiety, depression, and somatoform disorders) highlight psychological processes and the number of somatic symptoms irrespective of the bodily system to which they refer. Depression and anxiety often present with somatic symptoms that may resolve with effective treatment of these disorders. In other cases the appropriate psychiatric diagnostic category is a somatoform disorder.

    The existence of parallel classificatory systems is confusing. Both have merits, and both are imperfect. For …

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