Andy
Retired committee member
Introduction
Regardless of cause, persistent somatic symptoms (synonymous with persistent physical symptoms) are distressing somatic complaints, which are present on most days for at least several months [1]. The term “persistent somatic symptoms” is therefore not linked to a specific cause of complaints; it is not a diagnosis, but a description of a condition based on clinical features. Persistent somatic symptoms, like any other symptoms, will always correspond to the subjective reality of the person experiencing them; no biomarker will be able to define this subjective experience. Although the term persistent somatic symptoms is aetiology-free in the literal sense, it is still very often misunderstood to be limited to functional somatic disorders, somatic symptom disorders, or so-called “medically unexplained symptoms,” the latter term in itself being highly problematic for both scientific and stigmatization reasons [2‒4]. This misunderstanding of persistent somatic symptoms reflects an unfortunate and scientifically outdated dualism of mind and body and does not do justice to the complexity and current scientific knowledge of symptom perception and biopsychosocial explanatory models. Of course, persistent somatic symptoms occur within somatic diseases, functional somatic disorders, mental disorders, and undiagnosed diseases [1]. In some cases, a somatic disease is the trigger for persistent somatic symptoms, which then may persist even after successful treatment of the somatic disease [5, 6].
Explanatory models for diverse persistent somatic symptoms such as pain, fatigue, gastroenterological, or neurological symptoms [1, 7, 8] have at least one feature in common: they usually involve biological, psychological, and social mechanisms and risk factors, i.e., they are biopsychosocial models. From this perspective, “transsymptomatically,” there are similarities but also differences in the postulated factors and mechanisms involved in the development of the various symptoms. Similarly, “transdiagnostically,” there are both commonalities and disease-specific factors and mechanisms for the development of the same persistent symptom in different diseases, such as fatigue in multiple sclerosis [9], post-stroke [10, 11], heart failure [12], inflammatory bowel disease [13], rheumatoid arthritis [14], or chronic fatigue syndrome [15]. In particular, factors of a psychosocial nature that contribute to symptom perception are likely to be common across diagnoses [1].
The aim of this editorial is to explore the possibilities of a transdiagnostic and transsymptomatic approach to persistent somatic symptoms, as based on the current state of science. The potential of such a transdiagnostic and transsymptomatic approach lies in achieving synergies in terms of science, understanding, and treatment of those affected.
Open access, https://karger.com/pps/article/doi/...5/Reconsidering-Persistent-Somatic-Symptoms-A
Regardless of cause, persistent somatic symptoms (synonymous with persistent physical symptoms) are distressing somatic complaints, which are present on most days for at least several months [1]. The term “persistent somatic symptoms” is therefore not linked to a specific cause of complaints; it is not a diagnosis, but a description of a condition based on clinical features. Persistent somatic symptoms, like any other symptoms, will always correspond to the subjective reality of the person experiencing them; no biomarker will be able to define this subjective experience. Although the term persistent somatic symptoms is aetiology-free in the literal sense, it is still very often misunderstood to be limited to functional somatic disorders, somatic symptom disorders, or so-called “medically unexplained symptoms,” the latter term in itself being highly problematic for both scientific and stigmatization reasons [2‒4]. This misunderstanding of persistent somatic symptoms reflects an unfortunate and scientifically outdated dualism of mind and body and does not do justice to the complexity and current scientific knowledge of symptom perception and biopsychosocial explanatory models. Of course, persistent somatic symptoms occur within somatic diseases, functional somatic disorders, mental disorders, and undiagnosed diseases [1]. In some cases, a somatic disease is the trigger for persistent somatic symptoms, which then may persist even after successful treatment of the somatic disease [5, 6].
Explanatory models for diverse persistent somatic symptoms such as pain, fatigue, gastroenterological, or neurological symptoms [1, 7, 8] have at least one feature in common: they usually involve biological, psychological, and social mechanisms and risk factors, i.e., they are biopsychosocial models. From this perspective, “transsymptomatically,” there are similarities but also differences in the postulated factors and mechanisms involved in the development of the various symptoms. Similarly, “transdiagnostically,” there are both commonalities and disease-specific factors and mechanisms for the development of the same persistent symptom in different diseases, such as fatigue in multiple sclerosis [9], post-stroke [10, 11], heart failure [12], inflammatory bowel disease [13], rheumatoid arthritis [14], or chronic fatigue syndrome [15]. In particular, factors of a psychosocial nature that contribute to symptom perception are likely to be common across diagnoses [1].
The aim of this editorial is to explore the possibilities of a transdiagnostic and transsymptomatic approach to persistent somatic symptoms, as based on the current state of science. The potential of such a transdiagnostic and transsymptomatic approach lies in achieving synergies in terms of science, understanding, and treatment of those affected.
Open access, https://karger.com/pps/article/doi/...5/Reconsidering-Persistent-Somatic-Symptoms-A
