Feeling bad in more ways than one: Comorbidity patterns of medically unexplained and psychiatric conditions

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Journal: Journal of General Internal Medicine. 2007 Jun;22(6):818-21.

Authors and affiliation: Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF, Buchwald D. Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA. [E-mail: ellschur@u.washington.edu ]

PMID: 17503107

Background: Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary care setting, such as:

  • Chronic Fatigue Syndrome,
  • Low back pain,
  • Irritable bowel syndrome,
  • Chronic tension headache,
  • Fibromyalgia,
  • Temporomandibular joint disorder,
  • Major depression,
  • Panic attacks,
  • And posttraumatic stress disorder.

Objective: To examine interrelationships among these 9 conditions.

Design: Using data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships.

Participants: 3,982 twins from the University of Washington Twin Registry.

Measurements: Twins self-reported a doctor's diagnosis of the conditions.

Results: Comorbidity among these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status.

Conclusions: These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients.

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