Treatment of Functional Somatic Symptoms

Treatment of Functional Somatic Symptoms

R Mayou, C Bass, M Sharpe, editors

Don Mills ON: Oxford University Press; 1995. 455 p

Somatic symptoms in the absence of physical disease continue to be amongst the most perplexing and frustrating problems facing clinicians. Patients with such symptoms take an inordinate amount of time, and a recent epidemiological paper in the Canadian Medical Association Journal (Demers 1995) showed how costly they are to the health care system. It is easy to turn them away, or “pass the buck” by referring them to another specialist, or send them back to their family doctor, but this does little to resolve the situation.

It is timely, therefore, to find a book that fully describes the management of these disorders. This field has been misunderstood because of the multiple use and misuse of words. The authors open with an excellent chapter on terminology. They review the many words used to describe these conditions and explain how and why they decided that “functional” was most appropriate. By “functional” they mean that there is an abnormality in the physical functioning of the body, but that this is not of a type or degree that can be detected by gross structural changes. They acknowledge, however, that in its current usage “functional” tends to imply psychogenesis.

The book is based on papers presented in 1992 at a conference in Oxford organized by the editors. The 3 editors are well-known authors and researchers in this field and have written or collaborated on the writing of many of the chapters in this book.

The book is divided into 6 parts. The “Introduction” has chapters on terminology, history, etiology, as well as an overview on treatment. “Treatment Methods” covers initial assessment, antidepressants, cognitive-behavioral and psychodynamic therapies. “Clinical Syndromes” includes hypochondriasis, multiple symptoms, chronic pain, psychological treatment, and dysmorphophobia. “Specific Symptoms” deals with irritable bowel syndrome, premenstrual syndrome, chronic fatigue syndrome, chronic pelvic pain, and chest pain. “Specific Populations”covers children and the elderly, and there is a final section that deals with management in primary care, in the general hospital, and with alternative treatments. Most of the chapters are well written, and the editors have included an introductory summary at the head of each chapter, which places the topic in perspective. The chapters on chronic pain and premenstrual tension are particularly good and I have yet to see a better summary of the minefield that is chronic fatigue. Despite the complexity of functional somatic symptoms and the difficulties in conducting quality research, it is of great interest to observe how approaches to management are converging (Mai 1995).

There are, however, some minor criticisms. There is some repetition, for example, on the use and application of cognitive therapy, in different parts of the book. In addition, the writer of the history chapter appears unaware of the key contribution that Pierre Briquet made during the mid-19th century to our contemporary understanding of this condition (Mai 1983). There is also a lack of consistency in terminology. In the opening chapter, for example, the authors state their reasons for rejecting the concept of “medically unexplained” symptoms, but this is the main term used by House in his chapter on the initial psychiatric assessment.

Despite these criticisms, the authors are to be congratulated on bringing together an excellent work. The book should be read and used by anyone involved in clinical work management or in research in this field. It is, however, expensive.