Somatization & fashionable diagnoses: illness as a way of life

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The history of "nondisease" dates back, at least 4000 years,
to early descriptions of hysteria. More recently somatization
became a part of the official diagnostic nomenclature by
creation of the DSM III category, "somatoform disorders."
Somatization can serve as a rationalization for psychosocial
problems or as a coping mechanism, and for some illness,
becomes a way of life. One variation of somatization can be
the "fashionable diagnosis", for example, fibromyalgia,
multiple chemical sensitivities, dysautonomia, and, in the
past, "reactive hypoglycemia". These disorders are
phenomenologically related to environmental or occupational
syndromes and mass psychogenic illness. Fashionable illnesses
are characterized by (i) vague, subjective multisystem
complaints, (ii) a lack of objective laboratory findings,
(iii) quasi-scientific explanations, (iv) overlap from one
fashionable diagnosis to another, (v) symptoms consistent with
depression or anxiety or both, (vi) denial of psychosocial
distress or attribution of it to the illness. Fashionable
diagnoses represent a heterogeneous collection of physical
diseases, somatization, and anxiety or depression. They are
final common symptomatic pathways for a variety of influences
including environmental factors, intrapersonal distress and
solutions to social problems. A fashionable diagnosis allows
psychosocial distress to be comfortably hidden from both the
patient and the physician, but premature labeling can also
mask significant physical disease. Hysteria remains alive and
well and one contemporary hiding place is fashionable illness.

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