# medically unexplained symptoms



## trbell (Nov 1, 2000)

This is a fairly good overview of research on illnesses and depression and anxiety:Medically unexplained physical symptoms, anxiety, and depression: ameta-analytic review.Journal: Psychosom Med. 2003 Jul-Aug;65(4):528-33.Authors: Henningsen P, Zimmermann T, Sattel H.Affiliation: Department of Psychosomatic Medicine, University ofHeidelberg, Heidelberg, Germany.Address reprint requests to: Peter Henningsen, MD, Department ofPsychosomatic Medicine, University Hospital, Thibautstrasse 2, 69115Heidelberg, Germany. Email: mailtoeter_henningsen###med.uni-heidelberg.deReceived for publication June 6, 2002; revision received October 15,2002.NLM Citation: PMID: 12883101OBJECTIVE: Our objective was to review and compare, with meta-analyticmethods, observational studies on the association of medicallyunexplained physical symptoms, anxiety, and depression with specialemphasis on healthy and organically ill control groups and on differenttypes of symptoms, measures, and illness behavior.METHODS: A search of MEDLINE and PsycLIT/PsycINFO for abstracts from 1980to April 2001 was performed; principal investigators in the field werecontacted and article reference lists were used to retrieve additionalrelevant articles. Two hundred forty-four studies were included on thebasis of consensus ratings if they fulfilled seven of eight inclusioncriteria pertaining to diagnostic accuracy and statisticalappropriateness. Five hundred twenty-two studies were deferred orexcluded. We focused specifically on the four functional somaticsyndromes for which there were sufficient numbers for meta-analyticintegration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD),fibromyalgia (FM), and chronic fatigue syndrome (CFS). Data wereextracted independently by two authors according to a prespecified codingmanual with up to 70 parameters per study.RESULTS: Effect sizes for the association of the four functional somaticsyndromes with depression and anxiety were of moderate magnitude but werehighly significant statistically when compared with healthy persons andcontrols with medical disorders of known organic pathology. Moreover,this association was significant whether depression was measured with orwithout somatic items. Chronic fatigue syndrome is characterized byhigher scores of depression, fibromyalgia by lower scores of anxiety thanirritable bowel syndrome. Consulting behavior and severity ofsomatization is related to higher levels of anxiety and depression.CONCLUSIONS: Meta-analytic integration confirms that the four functionalsomatic syndromes (IBS, NUD, FM, CFS) are related to (but not fullydependent on) depression and anxiety. At present, there is only limitedmeta-analytic evidence for the same sort of association for medicallyunexplained physical symptoms in general. In view of the relativeindependence from depression and anxiety, classification and treatment ofthese symptoms and syndromes as "common mental disorders" does not seemfully appropriate. --------------------------------------------- Send posts to mailto:CO-CURE###listserv.nodak.edu Join or leave the list at http://www.co-cure.org/sub.htm Select list topic options at http://www.co-cure.org/topics.htm Co-Cure Archives: http://listserv.nodak.edu/archives/co-cure.html ---------------------------------------------Bada


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## LaurieJ (Sep 3, 2002)

Just to make this clear:Anxiety and depression may have a relationship to FM, CFS, IBS and NUD but the authors are not implying that they are a cause.Right?


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## trbell (Nov 1, 2000)

This is an overview article summarizing research that has been done in many studies, so it's hard to really be clear. They do seem to be saying that anxiety can occur with all in different ways. It's basically an individual thing and it has nothing to say about the chicken and egg thing some people get into arguing about.Bada


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## LaurieJ (Sep 3, 2002)

Makes sense to me, but I can't help wondering if research like this doesn't dirvert attention from finding more objective and treatable "organic" causes. Not that I don't believe that the mind / body connection is valid. It is just that I do not believe you can separate out the mind from the body enough to come up with any results that can be applicable to finding the root cause of diseases of this sort or if you can in one individual, how it can be applied to another.. No matter how involved the mind is or is not, there must still be qualifiable and quantifiable processes going on that can be objectively studied. The mind part is just too elusive, diverse and individualistic to lend itself to this process and subsequent broad therapeuatic application, I would think. Heck, we don't even know what a mind is, is terms of concrete makeup.It seems that this is an exercise in futility: while the theory is good, there is no chance for application.Laurie(feeling very pessimestic and antagonistic today)


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## trbell (Nov 1, 2000)

There is some pretty good research, though, that hypnosis and CBT are very effective treatments here. It's similar to the situation in treating depression, I think, where even though it's as 'organic' problem as much as any of these disorders mentioned here, there is a ton of research that shows CBT is more cost effective as it can be done in a few sessions, more effective, and more long lasting than antidepressants even though the best treatment would be the right combination of medication and therapy for most.bada


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## earthgarden (Jun 3, 2003)

Hello,I just posted this to a Fybro posting.


> quote:


I am not sure how I stumbled upon this thread, but on reading some of the symptoms, I was amazed because I have had some of the 'pains' and one of my favourite phrases was 'My brain's not working at the moment!' I was very worried and so decided to get fit! I suffered emotional trauma and was diagnosed with PTS (post traumatic stress) and felt that my symptoms were as a result of this. I started to meditate first to ease the stress, which helped and so I took up yoga, which helped and then I decided to go swimming also, which helped and then I started to have a weekly sauna for relaxation and this helped too. I don't know if it was helping to take my mind of my 'illness' or 'digestive disorders' or simply ease the stress that led to the 'illnesses, pains and digestive disorders'. Anyway, I read that taking fish oils was good for depression and was also an anti inflammatory so I started to take this too. I noticed that I was eating less, felt more positive in general and my digestion was definitely better and my IBS-C had improved dramatically.I am not sure whether it is a positive attitude that is the key or eating less. It's my approach to tackling my symptoms anyway.Other people's oppinions and theories are always welcome.


> quote:


I would welcome your theory and oppinion.


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## LaurieJ (Sep 3, 2002)

My opinion, earthgarden, is firstly "good for you". I think that you have very solidly identified ways that ease your discomfort and manage your condition. This is a very good anecdotal example of how a person can take control over something that seems to be overwhelming and make it better!. But at the same time, I caution you to not apply your personal success to everyone else's situation. While it is true that stress reduction, positive thinking, eating more heathily and taking "care of yourself" are all significant steps in feeling better, it can also be be mis-applied by virtue of its simplicity (well, not that it is easy to identify where changes need to be made in a life, and then to apply those changes, I don't think that at all). What I mean is that the opposite side of your solution can lead to a lot of mental anguish. Imagine for example that you are told over and over again that you have the power to make your illness / hurt go away and you sincerely try to and it doesn't; then you come to learn that all along there was a treatable defect in your system, that if taken care of, will eliminate the disease or disorder. But, because the mental or mind component has been emphasized for so long, this person now needs to unlearn that aspect of his / her illness and to stop blaming himself. Or what if, by delaying treatment, while encouraging a "mind over matter" approach instead, the disease or illness gets worse or even becomes untreatable? This is what alarms me to a certain extent about those that concentrate on the mental or mind component of an illness at the exclusion of any measurable, objective signs or symptoms of a disease. That is all I am trying to point out with concentrating on the mental health / lifestyles of persons and making judgments about them: CAUTION!I wish you well and hope you get more responses to your inquiry.Laurie


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## Guest (Aug 4, 2003)

I have to agree with LaurieJ here. Her logic applies to many different health arenas. I have personally experienced thinking I was a failure because I couldn't correct something that was organic in origin.Evie


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## trbell (Nov 1, 2000)

mind/body means mind and body, it doesn't mean one or the other.Bada


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