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on 17 December 2014
Great read and Excellent guide
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on 7 September 2011
Contains the usual egregious and very harmful misrepresentations (on the so-called 'functional somatic syndromes') that are the stock in trade of Prof. Simon Wessely. If this chapter is deleted in future printings or all of the misrepresentations rectified (it would be much more practical to throw this chapter out and start from scratch), I would be very happy to change my review to five stars. Please contact me if you are willing to discuss this. Thank you very much.

From the Book pp.125-148:

"Chapter: Functional somatic syndromes

Definition and Terminology

The functional somatic syndromes refer to a number of related syndromes that have been characterised by the reporting of somatic symptoms and resultant disability rather than on the evidence of underlying conventional disease pathology....all however share the feature of a disconnection between subjective symptomatology and objective biomedical pathology.

Chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia have been more extensively researched than most other FSS which has led to specific pathophysiological mechanisms being advanced for each. Nevertheless...it remains the case that the similarities between the different FSS are sufficiently striking for there to be a compelling case for considering them together (Barksy & Borus, 1999; Wessely et al, 1999).

The standard (medical) diagnostic criteria for FSS usually require specific symptoms to be present, whereas psychiatric classification (under the somatoform disorders) emphasises the number of symptoms.

Patients with FSS have been rated as one of the three most common types of patients that are `difficult to help' (Sharpe 1994)....The tendency of those with FSS to turn to alternative medicines for treatment is likely to be ...because alternative remedies often endorse the FSS patient's own physical illness attributions (Moss'Morris et al 2003).

Illness beliefs

At present, chronic fatigue syndrome is the functional somatic syndrome for which there is most evidence that beliefs about the illness may impact on the course of the illness itself. Patients with chronic fatigue syndrome are more likely to make physical illness attributions (rather than normalising or psychologising attributions) for a selection of common symptoms compared to controls (Butler et al 2001) and are more likely to believe their illness will be chronic...

These beliefs and attitudes about symptoms may act as a mechanism that then guides the patient to adopt avoidant behaviours....In fact, it is a change to beliefs about avoidance...that predicts good outcome from cognitive behavioural therapy in chronic fatigue syndrome (Deale et al 1998), highlighting the need for more research into the way illness attributions maintain ill'health.

Social factors

Several of the functional somatic syndromes, including chronic fatigue syndrome, GWS (Gulf War Syndrome) and repetitive strain injury have gained public credibility in spite of widespread medical scepticism as to their very existence. This phenomenon has been attributed to changes within society, including the erosion of the physician's traditional role...Patient support groups...may have some negative consequences, for example, membership of a chronic fatigue syndrome support group has been associated with poorer prognosis (Bentall et al 2002, Sharpe et al 1992).

The financial `reward' to be gained from disability payments or litigation has been argued as playing a role in the maintenance of ill health in those suffering from functional somatic syndromes...For example being in receipt of sickness benefit has been shown to be a poor prognostic sign in chronic fatigue syndrome (Bentall et al 2002, Cope et al 1994).


Psychosocial treatments such as cognitive behavioural therapy have been shown to be beneficial in a range of somatoform disorders...including the most researched functional somatic syndromes (i.e. chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia).


The functional somatic syndromes share many similarities in terms of symptomatic overlap and effective treatments as well as non'symptomatic characteristics; these observations imply that it may be unhelpful to regard each as a separate condition.

pp. 125-148"
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