Gulf War syndrome may signal mental ills.

A mysterious and controversial illness said to afflict many veterans of the 1991 Persian Gulf War may often stem from mood and anxiety disorders rather than wartime exposure to infectious agents or toxins, a new study finds.

On closer examination, diagnoses of Gulf War syndrome are often replaced by findings of depression, stress reactions, and related disturbances, reports a team led by internist Michael J. Roy of the Uniformed Services University of the Health Sciences in Bethesda, Md.

"Many patients with [Gulf War syndrome] may in fact have treatable mood or anxiety disorders rather than mystery illnesses," Roy and his coworkers contend in the November/December Psychosomatic Medicine. Their study, however, does not exclude the possibility that some Gulf War veterans suffer from an illness sparked by exposure to toxic substances.

Symptoms linked with Gulf War syndrome include fatigue, headaches, sleep disorders, and memory loss. There are no clear guidelines for diagnosing this condition, although veterans need an illness diagnosis to qualify for government medical benefits (SN: 10/15/94, p. 252).

Roy's group reviewed data from comprehensive medical examinations of 21,579 Persian Gulf veterans who had complained of health problems. Of that number, 17 percent exhibited one or more symptoms that can be related to Gulf War syndrome, which include evidence of infection; another 25 percent displayed signs of Gulf War syndrome and also of a separate health problem.

The 2,306 veterans who had the most pronounced symptoms of Gulf War syndrome received further exams by internists, psychiatrists, and infectious disease specialists. These close evaluations yielded large drops in the proportion of diagnosed symptoms that the clinicians attributed to Gulf War syndrome. The physicians assigned just 18 percent of all diagnosed symptoms to the syndrome in these follow-up exams, compared with 30 percent in the initial assessments of all veterans with any signs of Gulf War syndrome.

After these intensive evaluations--particularly those conducted at Walter Reed Army Medical Center in Washington, D.C., which convenes weekly meetings of physicians and mental health workers to discuss diagnoses--the physicians often noted the presence of mood disorders or post-traumatic stress disorder.

Symptoms of Gulf War syndrome may often arise as part of mood and anxiety disturbances, the scientists conclude. These mental disorders are often accompanied by the exact same problems--fatigue, headaches, sleep disturbances, and memory loss.

The new study raises concerns about the inappropriate labeling of psychiatric ailments such as Gulf War syndrome, comment psychiatrist Allen J. Frances and psychologist Jean C. Beckham, both of Duke University Medical Center in Durham, N.C., in an accompanying editorial. Long-term investigations, however, will be required to address whether some Gulf War veterans indeed suffer from a distinct illness caused by toxic exposure, they say.