The Psychopathology of Functional Somatic Syndromes: Neurobiology and Illness Behavior in Chronic Fatigue Syndrome, Fibromyalgia, Gulf War Illness, Irritable Bowel, and Premenstrual Dysphoria.

The Psychopathology of Functional Somatic Syndromes: Neurobiology and Illness Behavior in Chronic Fatigue Syndrome, Fibromyalgia, Gulf War Illness, Irritable Bowel, and Premenstrual Dysphoria Manu P. Binghamton, NY 13904, The Haworth Medical Press, 2004, hardcover/ paperback, 299 pp, ISBN: 0-7890-1259-6 (hardcover), 0-7890-1260-X (paperback), $79.95 (hardcover), $34.95 (paperback).

The author of this book is a physician and professor of clinical psychiatry who is writing for a target audience of mental health and primary health care providers. His fundamental premise is that a cluster of diagnoses--including chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, premenstrual dysphoria, and postcombat ailments--can be grouped as "functional somatic syndromes." The common somatic descriptors linking them all include chronic musculoskeletal or abdominal pain, persistent fatigue, sleep disturbance, and cognitive deficits.

Manu acknowledges the confusion and frustration expressed by physicians who are attempting to treat patients presenting with functional somatic syndromes, noting that 93% felt these diagnoses were difficult to manage and that a solid majority felt these diagnoses were best explained by mental illness rather than physical disorders. He quotes one physician as saying, "I would like to have the courage to tell them that nothing is wrong.... You must try to learn to live with your symptoms." In response to this frustration, the author wrote this book to examine recent empirical evidence related to these diagnoses and ultimately to make a case for his own theory of functional somatic syndromes.

The book is divided into 4 parts. The first describes the evolution of the modern diagnoses of chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, premenstrual dysphoria, and postcombat ailments (eg, Gulf War illness and posttraumatic stress disorder). This review provides a useful historical perspective on how these diagnoses came into being, and it makes the argument that these are a lightly knit family of syndromes.

The second part looks at the frequency of psychiatric disorders, such as depression, anxiety, and mood disorders, found in those diagnosed with functional somatic syndromes. The third part focuses on the psychobiology of these diagnoses, including discussions of neuroanatomy, brain perfusion, serotonin metabolism, and hypothalamic-pituitary-adrenal function. The fourth section observes the roles of abnormal personality traits (hypochondriasis, neuroses, obsessive-compulsive disorder, narcissism), sexual victimization, and maladaptive coping in those diagnosed with functional somatic syndromes.

In his analysis, Manu rejects or refines previous theories explaining the etiology of functional somatic syndromes. He cites recent research to refute that there is it psychiatric (eg, depression), neuroanatomical (eg, hypoperfusion), or neurobiological (eg, serotonin deficiency) basis for these diseases. Instead, he argues that functional somatic syndromes are reflective of personality traits, family history, prior individual experiences, sexual and physical abuse, and a catastrophic coping style. The severity of the symptoms, according to Manu, often worsens as medical treatment progresses to specialized care kind patient/doctor relationships become strained. He admit that psychiatric disorders may influence the manifestation or severity of these illnesses, but he argues that they are not the cause. Rather, it is the interaction of personality abnormalities (passive-dependent, histrionic, sensitive-aggressive) with life situations that leads to complaining, resistance to treatment, and persistence or worsening of the illness.

The book is text driven with no charts or photographs. The author spends a lot of time reviewing the individual research papers he uses in his analysis. In effect, he has eschewed a meta-analysis approach, creating instead an extensive annotated bibliography with references listed for each chapter. The references were published in the past 2 decades and come from peer-reviewed sources. Although a strength of the book is its exacting analysis of the research, a shortcoming is the paucity of suggestions on how to apply this knowledge. Although Manu acknowledges the frustration of primary health care providers in managing these patients, he is unable to provide much practical assistance. Another shortcoming is that health care providers who do not have a psychiatric background may have difficulty in understanding the distinctions between psychiatric disorders and personality disorders because there are no easy-to-find definitions or glossary provided in this text. Although the writing is straightforward, it is rather dry and includes extensive statistical material within the text. There are no case studies or patient profiles that could help bring the research to life.

With some exceptions, this book would be of minimal benefit to physical therapists. There is no need for this book in a DPT or physical therapist assistant curriculum. It might be of interest to those who have a practice specializing in fibromyalgia, chronic fatigue, or pelvic pain and who are looking for theoretical explanations for these diagnoses. They will find no practical intervention approaches, however. The book might also be of interest to physical therapists who are conducting research on how affective domain characteristics such as personality traits or elevated fear avoidance influence physical therapy intervention. The discussion and references could be useful in helping to refine questions or stimulate avenues of research.

Ann M York, PT, PhD

Des Moines University 

Des Moines, Iowa 

Dr York is Assistant Professor and Academic Coordinator for Clinical Education in the Professional DPT Program. She previously served as adjunct faculty in the Psychology Department at Lincoln Trail College, Robinson, Ill.