Classification of functional syndromes

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Most functional symptoms are transient, but a sizeable minority become persistent. Persistent symptoms are often multiple and disabling and may be described as functional syndromes. Although different medical and psychiatric classifications of functional syndromes exist, these are simply alternative ways of describing the same conditions.

Medical syndromes (such as fibromyalgia and chronic fatigue, chronic pain, and irritable bowel syndromes) highlight patterns of somatic symptoms, often in relation to particular bodily systems. Although they are useful in everyday medical practice, recent studies show there is substantial overlap between them.

Psychiatric syndromes (such as anxiety, depression, and somatoform disorders) highlight psychological processes and the number of somatic symptoms irrespective of the bodily system to which they refer. Depression and anxiety often present with somatic symptoms that may resolve with effective treatment of these disorders. In other cases the appropriate psychiatric diagnostic category is a somatoform disorder.

The existence of parallel classificatory systems is confusing. Both have merits, and both are imperfect. For many functional symptoms, a simple description of the symptom qualified with the descriptors single or multiple and acute or chronic may suffice. When diagnosis of a functional syndrome seems appropriate a combination of medical and psychiatric descriptors conveys the most information, such as "irritable bowel syndrome with anxiety disorder."

A major obstacle to effective management is patients feeling disbelieved by their doctor. Patients who present with symptoms that are not associated with disease may be thought by some to be "putting it on." The deliberate manufacture of symptoms or signs, however, is probably rare in ordinary practice.

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