Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2007
  • Online publication date: December 2009

7 - Functional somatic syndromes

from Part II - Common psychiatric problems across the general hospital


The functional somatic syndromes (FSS) refer to a number of related syndromes that have been characterized by the reporting of somatic symptoms and resultant disability rather than on the evidence of underlying conventional disease processes. 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. There is limited data on the predisposing and precipitating factors in FSS. A history of childhood abuse is more common in those who suffer from irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia. Cognitive behavioural therapy and exercise therapy appear to lead to therapeutic change by tackling biological and psychosocial factors, whilst centrally acting drugs such as antidepressants can sometimes be helpful. For many of the less well recognized FSS, operationalized diagnostic criteria are lacking, as are high quality treatment trials.

Related content

Powered by UNSILO
Aaron, L. and Buchwald, D. (2001). A review of the evidence for overlap among unexplained clinical conditions. Annals of Internal Medicine, 134 (9), 868–81.
Afari, N. and Buchwald, D. (2003). Chronic fatigue syndrome: a review. American Journal of Psychiatry, 160, 221–36.
Akehurst, R. and Kaltenthaler, E. (2001). Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut, 48, 272–82.
Al-Allaf, A. W., Dunbar, K. L., Hallum, N. S., et al. (2002). A case-control study examining the role of physical trauma in the onset of fibromyalgia syndrome. Rheumatology, 41 (4), 450–3.
Al-Ani, M., Davies, S., Gray, R. J., et al. (2004). Stabilisation splint therapy for temoporomandibular pain dysfunction syndrome (Cochrane Review). Cochrane Library. Chichester: John Wiley & Sons Ltd.
Allen, L., Escobar, J., Lehrer, P. M., et al. (2002). Psychosocial treatments for multiple unexplained physical symptoms: a review of the literature. Psychosomatic Medicine, 64 (6), 939–50.
Anderberg, U., Marteinsdottir, I., Theorell, T., et al. (2000). The impact of life events in female patients with fibromyalgia and in female healthy controls. European Psychiatry, 15, 295–301.
Arksey, H. (1994). Expert and lay participation in the construction of medical knowledge. Sociology of Health and Illness, 16 (4), 448–68.
Arnold, L. M., Keck, P. E. and Welge, J. A. (2000). Antidepressant treatment of fibromyalgia. A meta-analysis and review. Psychosomatics, 41, 104–13.
Asbring, P. and Narvanen, A. (2002). Women's experiences of stigma in relation to chronic fatigue syndrome. Qualitative Health Research, 12 (2), 148–60.
Barsky, A. and Borus, J. (1999). Functional somatic syndromes. Annals of Internal Medicine, 130, 910–21.
Bazelmans, E., Bleijenberg, G., Meer, J. N., et al. (2001). Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity. Psychological Medicine, 31, 107–14.
Bell, I., Baldwin, C. and Schwartz, G. E. (1998). Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. American Journal of Medicine, 105, 74S–82S.
Bennett, E., Tennant, C., Piesse, C., et al. (1998). Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut, 43, 256–61.
Bentall, R., Powell, P., Nye, F. J., et al. (2002). Predictors of response to treatment for chronic fatigue syndrome. British Journal of Psychiatry, 181, 248–52.
Brandt, L., Bjorkman, D., Fennerty, M. B., et al. (2002). Systematic review on the management of irritable bowel syndrome in North America. American Journal of Gastroenterology, 97 (11), S7–26.
Buchwald, D. and Garrity, D. (1994). Comparison of patients with chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivities. Archives of Internal Medicine, 154, 2049–53.
Buchwald, D., Herrell, R., Ashton, S., et al. (2001). A twin study of chronic fatigue. Psychosomatic Medicine, 63, 936–43.
Busch, A., Schachter, C., Peloso, P. M., et al. (2002). Exercise for treating fibromyalgia syndrome (Cochrane Review). The Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons Ltd.
Butler, J., Chalder, T. and Wessely, S. (2001). Causal attributions for somatic sensations in patients with chronic fatigue syndrome and their partners. Psychological Medicine, 31, 97–105.
Candy, B., Chalder, T., Cleare, A. J., et al. (2003). Predictors of fatigue following the onset of infectious mononucleosis. Psychological Medicine, 33, 847–55.
Chambers, D., Bagnall, A. -M., Hempel, S., et al. (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine, 99, 506–20.
Ciccone, D. and Natelson, B. (2003). Comorbid illness in women with chronic fatigue syndrome: a test of the single syndrome hypothesis. Psychosomatic Medicine, 65, 268–75.
Cleland, L. (1987). ‘RSI’: a model of social iatrogenesis. Medical Journal of Australia, 147 (5), 236–9.
Cook, D., Lange, G., Ciccone, D. S., et al. (2004). Functional imaging of pain in patients with primary fibromyalgia. Journal of Rheumatology, 31, 364–78.
Cope, H., David, A., Pelosi, A., et al. (1994). Predictors of chronic ‘postviral’ fatigue. Lancet, 344, 864–8.
Craig, T., Boardman, A., Mills, K., et al. (1993). The South London somatisation study I: longitudinal course and the influence of early life experiences. British Journal of Psychiatry, 163, 579–88.
Craig, T., Drake, H., Mills, K., et al. (1994). The South London somatisation study II: influence of stressful life events and secondary gain. British Journal of Psychiatry, 165, 248–58.
Creed, F., Craig, T. and Farmer, R. (1988). Functional abdominal pain, psychiatric illness and life events. Gut, 29, 235–42.
Deale, A., Chalder, T. and Wessely, S. (1998). Illness beliefs and treatment outcome in chronic fatigue syndrome. Journal of Psychosomatic Research, 45 (1), 77–83.
Deale, A. and Wessely, S. (2001). Patients' perceptions of medical care in chronic fatigue syndrome. Social Science & Medicine, 52, 1859–64.
Deary, I. (1999). A taxonomy of medically explained symptoms. Journal of Psychosomatic Research, 47 (1), 51–9.
Dunnell, K. and Cartwright, A. (1972). Medicine Takers, Prescribers and Hoarders. London: Routledge, Kegan Paul.
Evans, B., Clark, W., Moore, D. J., et al. (2004). Tegaserod for the treatment of irritable bowel syndrome (Cochrane Review). Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons Ltd.
Farmer, A., Scourfield, J., Martin, N., et al. (1999). Is disabling fatigue in childhood influenced by genes?Psychological Medicine, 29, 279–82.
Fiedler, N., Kipen, H., DeLuca, J., et al. (1996). A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome. Psychosomatic Medicine, 58, 38–49.
Fukudo, S., Nomura, T. and Hongo, M. (1998). Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut, 42 (6), 845–9.
Fulcher, K. Y. and White, P. D. (2000). Strength and physiological response to exercise in patients with chronic fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 69, 302–7.
Gillespie, N., Zhu, G., Heath, A. C., et al. (2000). The genetic aetiology of somatic distress. Psychological Medicine, 30, 1051–61.
Goldenberg, D., Simms, R., Geiger, A., et al. (1990). High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis and Rheumatism, 33 (3), 381–7.
Gomborone, J., Dewsnap, P., Libby, G., et al. (1995). Abnormal illness attitudes in patients with irritable bowel syndrome. Journal of Psychosomatic Research, 39 (2), 227–30.
Gwee, K. A., Graham, J. C., McKendrick, W., et al. (1996). Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet, 347, 150–3.
Hadhazy, V., Ezzo, J., Creamer, P., et al. (2000). Mind-body therapies for the treatment of fibromyalgia. A systematic review. Journal of Rheumatology, 27 (12), 2911–18.
Hadler, N. (1993). The dangers of the diagnostic process: iatrogenic labeling as in the fibromyalgia paralogism. Occupational Musculoskeletal Disorders. New York: Raven Press, pp. 16–33.
Hahn, S. (2001). Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Annals of Internal Medicine, 134, 897–904.
Hannay, D. (1978). Symptom prevalence in the community. Journal of the Royal College of General Practitioners, 28, 492–9.
Hatcher, S. and House, A. (2003). Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study. Psychological Medicine, 33, 1185–92.
Hazemeijer, I. and Rasker, J. (2003). Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting. Rheumatology, 42, 507–15.
Hickie, I., Hadzi-Pavlovic, D., Parker, G., et al. (1995). Can the chronic fatigue syndrome be defined by distinct clinical features?Psychological Medicine, 25, 925–35.
Hickie, I., Kirk, K. and Martin, N. (1999). Unique genetic and environmental determinants of prolonged fatigue: a twin study. Psychological Medicine, 29, 259–68.
Hotopf, M., Noah, N. and Wessely, S. (1996). Chronic fatigue and minor psychiatric morbidity after viral meningitis: a controlled study. Journal of Neurology, Neurosurgery and Psychiatry, 60 (5), 504–9.
Hotopf, M., Mayou, R., Wadsworth, M., et al. (1998). Temporal relationships between physical symptoms and psychiatric disorder: results from a national birth cohort. British Journal of Psychiatry, 173, 255–61.
Hotopf, M., Mayou, R., Wadsworth, M., et al. (1999). Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. American Journal of Psychiatry, 156 (11), 1796–800.
Hudson, J., Goldenberg, D., Pope, H. G. Jr, et al. (1992). Comorbidity of fibromyalgia with medical and psychiatric disorders. American Journal of Medicine, 92, 363–7.
Jailwala, J., Imperiale, T. and Kroenke, K. (2000). Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Annals of Internal Medicine, 133, 136–47.
Jason, L., Richman, J., Rademaker, A. W., et al. (1999). A community-based study of chronic fatigue syndrome. Archives of Internal Medicine, 159, 2129–37.
Joyce, J., Hotopf, M. and Wessely, S. (1997). The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine, 90, 223–33.
Karjalainen, K., Malmivaara, A., Tulder, M., et al. (1999). Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults (Cochrane Review). Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons Ltd.
Karjalainen, K., Malmivaara, A., Tulder, M., et al. (2000). Biopsychosocial rehabilitation for upper limb repetitive strain injuries in working age adults (Cochrane Review). Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons Ltd.
Kay, L., Jorgensen, T. and Jensen, K. H. (1994). The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors. Journal of Internal Medicine, 236, 23–30.
Kisely, S. R. (2002). Treatments for chronic fatigue syndrome and the internet: a systematic survey of what your patients are reading. Australian and New Zealand Journal of Psychiatry, 36, 240–5.
Kisely, S., Campbell, L. and Skerrit, P. (2005). Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database of Systematic Reviews. Chichester, John Wiley & Sons Ltd.
Kroenke, K. and Price, R. (1993). Symptoms in the community: prevalence, classification and psychiatric comorbidity. Archives of Internal Medicine, 153, 2474–80.
Kroenke, K. and Spitzer, R. (1998). Gender differences in the reporting of physical and somatoform symptoms. Psychosomatic Medicine, 60 (2), 150–5.
Kroenke, K. and Swindle, R. (2000). Cognitive-behavioural therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics, 69, 205–15.
Kroenke, K., Spitzer, R., Williams, J. B., et al. (1994). Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Archives of Family Medicine, 3, 774–9.
Kwiatek, R., Barnden, L., Tedman, R., et al. (2000). Regional cerebral blood flow in fibromyalgia. Arthritis and Rheumatism, 43 (12), 2823–33.
Levy, R. L., Whitehead, W. E., Korff, M. R., et al. (2000). Intergenerational transmission of gastrointestinal illness behavior. American Journal of Gastroenterology, 95 (2), 451–6.
Levy, R. L., Jones, K. R., Whitehead, W. E., et al. (2001). Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology, 121 (4), 799–804.
Lewis, D., Mayberg, H., Fishcher, M. E., et al. (2001). Monozygotic twins discordant for chronic fatigue syndrome: regional cerebral blood flow SPECT. Radiology, 219, 766–73.
List, T., Axelsson, S. and Leijon, G. (2003). Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain and burning mouth syndrome. A qualitative systematic review. Journal of Orofacial Pain, 17 (4), 301–10.
Looper, K. and Kirmayer, L. (2004). Perceived stigma in functional somatic syndromes and comparable medical conditions. Journal of Psychosomatic Research, 57, 373–8.
Lyall, M., Peakman, M. and Wessely, S. (2003). A systematic review and critical evaluation of the immunology of chronic fatigue syndrome. Journal of Psychosomatic Research, 55, 79–90.
MacHale, S., Lawrie, S., Cavanagh, J. T., et al. (2000). Cerebral perfusion in chronic fatigue syndrome and depression. British Journal of Psychiatry, 176, 550–6.
MacLean, G. and Wessely, S. (1994). Professional and popular representations of chronic fatigue syndrome. British Medical Journal, 308, 776–7.
Malleson, A. (2002). Whiplash and Other Useful Illnesses. Toronto: McGill-Queen's University Press.
Manu, P., Lane, T. and Matthews, D. A. (1989). Somatization disorder in patients with chronic fatigue. Psychosomatics, 30 (4), 388–95.
Mayou, R., Levenson, J. and Sharpe, M. (2003). Somatoform disorders in DSM-V. Psychosomatics, 44 (6), 449–51.
McGowan, L., Clark-Carter, D., Pitts, M. K., et al. (1998). Chronic pelvic pain: a meta-analytic review. Psychology and Health, 13, 937–51.
Mertz, H., Morgan, V., Tanner, G., et al. (2000). Regional cerebral activation in irritable bowel syndrome and control subjects with painful and non-painful rectal distension. Gastroenterology, 118, 842–8.
Morris-Yates, A., Talley, N. J., Boyce, P. M., et al. (1998). Evidence of a genetic contribution to functional bowel disorder. American Journal of Gastroenterology, 93 (8), 1311–17.
Moss-Morris, R. and Spence, M. (2006). To ‘lump’ or ‘split’ the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome?Psychosomatic Medicine, 68, 463–9.
Moss-Morris, R. and Wrapson, W. (2003). Representational beliefs about functional somatic syndromes. In The Self-regulation of Health and Illness Behaviour, ed. Cameron, L. and Leventhal, H.. New York: Routledge, pp. 119–37.
Mouterde, O. (2001). Myalgic encephalomyelitis in children. Lancet, 357 (9255), 562.
Naliboff, B., Derbyshire, S., Munakata, J., et al. (2001). Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosomatic Medicine, 63, 365–75.
Neumann, L. and Buskila, D. (2003). Epidemiology of fibromyalgia. Current Pain & Headache Reports, 7, 362–8.
Nimnuan, C., Rabe-Hesketh, S., Wessely, S., et al. (2001). How many functional somatic syndromes?Journal of Psychosomatic Research, 51 (4), 549–57.
Page, L. and Wessely, S. (2003). Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. Journal of the Royal Society of Medicine, 96, 223–7.
Parker, A., Wessely, S. and Cleare, A. J. (2001). The neuroendocrinology of chronic fatigue syndrome and fibromyalgia. Psychological Medicine, 31, 1331–45.
Peters, S., Stanley, I., Rose, M., et al. (1998). Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care. Social Science & Medicine, 46(4–5), 559–65.
Potts, S. and Bass, C. (1993). Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long term follow up study. Quarterly Journal of Medicine, 86, 583–93.
Price, J. and Couper, J. (1998). Cognitive behavioural therapy for chronic fatigue syndrome in adults (Cochrane Review). The Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons Ltd.
Reid, J., Ewan, C. and Lowy, E. (1991). Pilgrimage of pain: the illness experiences of women with repetition strain injury and the search for credibility. Social Science & Medicine, 32 (5), 601–12.
Reilly, J., Baker, G., Rhodes, J., et al. (1999). The association of sexual and physical abuse with somatization: characteristics of patients presenting with irritable bowel syndrome and non-epileptic attack disorder. Psychological Medicine, 29, 399–406.
Ring, A., Dowrick, C., Humphris, G., et al. (2004). Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study. British Medical Journal, 328, 1057.
Ring, A., Dowrick, C., Humphris, G. M., et al. (2005). The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Social Science and Medicine, 61, 1505–15.
Robbins, J. and Kirmayer, L. (1990). Illness worry and disability in fibromyalgia syndrome. International Journal of Psychiatry in Medicine, 20, 49–63.
Robbins, J., Kirmayer, L. and Hemani, S. (1997). Latent variable models of functional somatic distress. The Journal of Nervous and Mental Disease, 185, 606–15.
Rossy, L., Buckelew, S., Dorr, N., et al. (1999). A meta-analysis of fibromyalgia treatment interventions. Annals of Behavioral Medicine, 21 (2), 180–91.
Saito, Y., Locke, R., Talley, N. J., et al. (2000). A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. American Journal of Gastroenterology, 95, 2816–24.
Salmon, P. and Marchant-Haycox, S. (2000). Surgery in the absence of pathology. The relationship of patients' presentation to gynaecologists' decisions for hysterectomy. Journal of Psychosomatic Research, 49, 119–24.
Schmaling, K., Lewis, D., Fiedelak, J. I., et al. (2003). Single-photon emission computerized tomography and neurocognitive function in patients with chronic fatigue syndrome. Psychosomatic Medicine, 65, 129–36.
Schrader, H., Obelieniene, D., Bovim, G., et al. (1996). Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet, 347, 1207–11.
Sharpe, M. and Bass, C. (1992). Pathophysiological mechanisms in somatisation. International Review of Psychiatry, 4, 81–97.
Sharpe, M. and Carson, A. (2001). ‘Unexplained’ somatic symptoms, functional syndromes and somatization: do we need a paradigm shift?Annals of Internal Medicine, 134, 926–30.
Sharpe, M., Hawton, K., Seagroatt, V., et al. (1992). Follow up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal, 305, 147–52.
Sharpe, M., Mayou, R., Seagroatt, V., et al. (1994). Why do doctors find some patients difficult to help?Quarterly Journal of Medicine, 87, 187–93.
Shorter, E. (1995). Sucker-punched again! Physicians meet the disease-of-the-month syndrome. Journal of Psychosomatic Research, 39 (2), 115–18.
Silverman, D., Munakata, J., Ennes, H., et al. (1997). Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology, 112, 64–72.
Sim, J. and Adams, N. (2002). Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia. The Clinical Journal of Pain, 18, 324–36.
Sullivan, P., Smith, W. and Buchwald, D. (2002). Latent class analysis of symptoms associated with chronic fatigue syndrome and fibromyalgia. Psychological Medicine, 32, 881–8.
Sullivan, P., Evengard, B., Jacks, A., et al. (2005). Twin analyses of chronic fatigue in a Swedish national sample. Psychological Medicine, 35, 1327–36.
Talley, N. and Spiller, R. (2002). Irritable bowel syndrome: a little understood organic bowel disease?Lancet, 360, 555–64.
Taylor, R., Jason, L. and Schoeny, M. E. (2001). Evaluating latent variable models of functional somatic distress in a community-based sample. Journal of Mental Health, 10 (3), 335–49.
Twemlow, S., Bradshaw, S. Jr, Coyne, L., et al. (1997). Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome. Psychological Reports, 80 (2), 643–58.
Valim, V., Oliveira, L., Suda, A. L., et al. (2002). Peak oxygen uptake and ventilatory anaerobic threshold in fibromyalgia. Journal of Rheumatology, 29, 353–7.
Van-Houdenhove, B., Neerinckx, E., Lysens, R., et al. (2001). Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care. Psychosomatics, 42, 21–8.
Verbrugge, L. and Ascione, F. (1987). Exploring the iceberg. Common symptoms and how people care for them. Medical Care, 25 (6), 539–69.
Verhagen, A., Bierma-Zeinstra, S., Feleus, A., et al. (2004a). Ergonomic and physiotherapeutic interventions for treating upper extremity work related disorders in adults (Cochrane Review). Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons Ltd.
Verhagen, A., Schotten-Peeters, G., Bie, R., et al. (2004b). Conservative treatments for whiplash. Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons Ltd.
Walker, E., Roy-Byrne, P., Katon, W. J., et al. (1990). Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel syndrome. American Journal of Psychiatry, 147, 1656–61.
Walsh, C., Zainal, N., Middleton, S. J., et al. (2001). A family history of chronic fatigue syndrome. Psychiatric Genetics, 11, 123–8.
Weinman, J., Petrie, K., Moss-Morris, R., et al. (1996). The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology and Health, 11, 431–45.
Wessely, S. (1990). Old wine in new bottles: neurasthenia and ‘ME'. Psychological Medicine, 20, 35–53.
Wessely, S. (1995). The epidemiology of chronic fatigue syndrome. Epidemiologic Reviews, 17, 139–51.
Wessely, S. (2001). Chronic fatigue: symptom and syndrome. Annals of Internal Medicine, 134, 838–43.
Wessely, S., Chalder, T., Hirsch, S., et al. (1996). Psychological symptoms, somatic symptoms and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. American Journal of Psychiatry, 153, 1050–9.
Wessely, S., Nimnuan, C. and Sharpe, M. (1999). Functional somatic syndromes: one or many?Lancet, 354, 936–9.
White, P., Thomas, J., Amess, J., et al. (1998). Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. British Journal of Psychiatry, 173, 475–81.
Whiting, P., Bagnall, A.-M., Sowden, A. J., et al. (2001). Interventions for the treatment and management of chronic fatigue syndrome. A systematic review. Journal of the American Medical Association, 286, 1360–8.
Wigers, S. (1996). Fibromyalgia outcome: the predictive values of symptom duration, physical activity, disability pension and critical life events – a 4.5 year prospective study. Journal of Psychosomatic Research, 41 (3), 235–43.
Wilson, A., Hickie, I., Hadzi-Pavlovic, D., et al. (2001). What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Australian and New Zealand Journal of Psychiatry, 35, 520–7.
Wolfe, F., Ross, K., Anderson, J., et al. (1995). The prevalence and characteristics of fibromyalgia in the general population. Arthritis and Rheumatism, 38 (1), 19–28.
Woodward, R., Broom, D. and Legge, D. G. (1995). Diagnosis in chronic illness: disabling or enabling – the case of chronic fatigue syndrome. Journal of the Royal Society of Medicine, 88, 325–9.
Zakrzewska, J., Forsell, H. and Glenny, A. (2004). Interventions for the treatment of burning mouth syndrome (Cochrane Review). Cochrane Database of Systematic Reviews. Chichester:John Wiley & Sons Ltd.