Review| Volume 128, ISSUE 10, P1054-1058, October 2015

Download started.


Somatic Symptom Disorders Without Known Physical Causes: One Disease with Many Names?

  • Morton E. Tavel
    Requests for reprints should be addressed to Morton E. Tavel, MD, FACP, FACC, Indiana University School of Medicine, St. Vincent Hospital, 5602 Elderberry Rd., Noblesville, IN 46062.
    Indiana University School of Medicine, St. Vincent Hospital, Indianapolis
    Search for articles by this author


      Patients complaining of pain or fatigue in the absence of known physical diseases constitute a high percentage of those seeking general medical care. Depending upon the type of physician/specialist consulted, those individuals may receive disease labels that range from an implied psychological origin such as somatoform or psychosomatic disease, or to a presumed physical disease such as fibromyalgia. Although all these conditions are regularly associated with fatigue, we have provided a new label suggesting another disease category, “systemic exertion intolerance disease,” which replaces the previous “chronic fatigue syndrome.” All these conditions have common, overlapping features that usually consist of both fatigue and pain, and, in the absence of definitive objective confirmation, might be best classified under one heading such as somatic symptom disorder. Management of these disorders is challenging, but suggestions for proper identification and treatment are presented.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Association, Arlington, VA2013
        • Meuret A.E.
        • Ritz T.
        Hyperventilation in panic disorder and asthma: empirical evidence and clinical strategies.
        Int J Psychophysiol. 2010; 78: 68-79
        • Tavel M.E.
        Hyperventilation syndrome and unilateral somatic symptoms.
        JAMA. 1964; 187: 301-302
        • Tavel M.E.
        Hyperventilation syndrome-hiding behind pseudonyms?.
        Chest. 1990; 97: 1285-1288
        • Magarian G.J.
        Hyperventilation syndromes: infrequently recognized common expressions of anxiety and stress.
        Medicine. 1982; 61: 219-236
        • Yunus M.B.
        Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness.
        Semin Arthritis Rheum. 2008; 37: 339-352
        • Bellato E.
        • Marini E.
        • Castoldi F.
        • et al.
        Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment.
        Pain Res Treat. 2012; (Epub 2012 Nov 4): 426130
        • Wolfe F.
        • Smythe H.A.
        • Yunus M.B.
        • et al.
        Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee.
        Arthritis Rheum. 1990; 33: 160-172
        • Wolfe F.
        New American College of Rheumatology criteria for fibromyalgia: a twenty-year journey.
        Arthritis Care Res (Hoboken). 2010; 62: 583-584
        • Aaron L.A.
        • Buchwald D.
        A review of the evidence for overlap among unexplained clinical conditions.
        Ann Intern Med. 2001; 134: 868-881
        • Clauw D.J.
        Fibromyalgia: an overview.
        Am J Med. 2009; 122: S3-S13
        • McBeth J.
        • Silman A.J.
        The role of psychiatric disorders in fibromyalgia.
        Curr Rheumatol Rep. 2001; 3: 157-164
        • deHeer E.W.
        • Gerrits M.J.G.
        • Beekmen A.T.F.
        • et al.
        The association of depression and anxiety with pain: a study from NESDA.
        PLoS One. 2014; 9: e106907
        • Giesecke T.
        • Williams D.A.
        • Harris R.E.
        • et al.
        Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors.
        Arthritis Rheum. 2003; 48: 2916-2922
        • Epstein S.A.
        • Kay G.
        • Clauw D.
        • et al.
        Psychiatric disorders in patients with fibromyalgia: a multicenter investigation.
        Psychosomatics. 1999; 40: 57-63
        • Kroenke K.
        • Wood D.R.
        • Mangelsdorff A.D.
        • et al.
        Chronic fatigue in primary care: prevalence, patient characteristics, and outcome.
        JAMA. 1988; 260: 929-934
        • Clayton E.W.
        Beyond myalgic encephalomyelitis/chronic fatigue syndrome. Institute of Medicine of the National Academies.
        JAMA. 2015; 313: 1101-1102
        • Skapinakis P.
        • Lewis G.
        • Mavreas V.
        Unexplained fatigue syndromes in a multinational primary care sample: specificity of definition and prevalence and distinctiveness from depression and generalized anxiety.
        Am J Psychiatry. 2003; 160: 785-787
        • Buchwald D.
        • Pearlman T.
        • Kith P.
        • et al.
        Screening for psychiatric disorders in chronic fatigue and chronic fatigue syndrome.
        J Psychosom Res. 1997; 42: 87-94
        • Mitchel A.J.
        • Chan M.
        • Bhatti H.
        • et al.
        Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: a meta-analysis of 94 interview-based studies.
        Lancet Oncol. 2011; 12: 160-174
        • Arnold L.M.
        Strategies for managing fibromyalgia.
        Am J Med. 2009; 122: S31-S43
        • Linde K.
        • Niemann K.
        • Schneider A.
        • et al.
        How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials.
        BMC Med. 2010; 23: 75
        • Vickers A.J.
        • Cronin A.M.
        • Maschino A.C.
        • et al.
        Acupuncture for chronic pain. Individual patient data meta-analysis.
        Arch Intern Med. 2012; 172: 1444-1453
        • Tavel M.E.
        The placebo effect: the good, the bad, and the ugly.
        Am J Med. 2014; 127: 484-488
        • Meissner K.
        • Fässler M.
        • Rücker G.
        • et al.
        Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis.
        JAMA Intern Med. 2013; 173: 1941-1951
        • Paterson C.
        • Griffiths P.
        • Britten N.
        Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study).
        Br J Gen Pract. 2011; 61: e295-e305
        • Deare J.C.
        • Zheng Z.
        • Xue C.C.L.
        • et al.
        Acupuncture for treating fibromyalgia.
        Cochrane Database Syst Rev. 2013; 5: CD007070