Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes

Abstract

The etiology of functional somatic syndromes or disorders (FSDs) is generally considered to be a multifactorial interplay between psychological, biological, and social factors. One of the most investigated biological factors is stress responsive system dysfunction. Despite more than twenty years of research of the autonomic nervous system and the hypothalamic-pituitary-adrenal axis, however, it is yet unknown whether dysfunctions in these systems play a causal role in the etiology of FSDs and whether they are generic or FSD-specific. In this review, we will give an overview of available evidence on whether or not alterations in these stress responsive systems can be considered causal risk factors of FSDs. We conclude that although not necessary factors for FSDs in general, lowered cardiac vagal activity and hypocortisolism may be pivotal in the etiology and treatment strategy in subgroups of subjects with a FSD. Such subgroups need to be better identified.

Symptoms and the body: Taking the inferential leap

“…The popularity of the amplification model relies in part on the observation that physical symptom reports are commonly comorbid with symptoms of anxiety and depression (Wessely et al, 1999;Kroenke, 2003) and consistently associated (r = 0.40-0.50) with higher trait negative affectivity (NA; i.e., a pervasive tendency to experience negative affect; Watson and Pennebaker, 1989) and elevated stress levels (Tak and Rosmalen, 2010). Increased symptom reports in primary care have often been interpreted as resulting from elevated autonomic arousal (Kolk et al, 2003;Kirmayer et al, 2004).…”

“…This picture applies to autonomic function as indicated by heart rate variability: a metaanalysis by Tak et al (2009) found no significant difference between patients with functional somatic disorders and healthy controls after controlling for publication bias. Another review found no differences between patients with functional somatic syndromes and healthy controls in half of the studies, and some evidence of reduced cardiac vagal activity in another half, depending also on the type of functional syndrome (Tak and Rosmalen, 2010). A systematic review of Van Cauwenbergh et al (2014) suggested a reduced cardiac response to a head-up tilt test in chronic fatigue patients in 7 of 8 studies.…”

Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism

“…Within this account, cognitive behavioural models have become increasingly popular [2][3][4][5]. These models propose a set of predisposing factors (e.g., genetics, personality characteristics, and life events), precipitating factors (e.g., physiological factors and general distress) and perpetuating factors (e.g., physiological, cognitive, behavioural, and social reactions) that each may contribute to the development and maintenance of CFS [3][4][5][6][7][8].…”

Feasibility of a Research Protocol to Investigate the Effect of the TherapressureTM Program Using Salivary Cortisol

“…However, whether the altered stress response is a causal factor or a result of the condition is unclear (Tak & Rosmalen, 2010). By contrast, hypocortisolism has also been identified in groups that are exposed to chronic stress, including children raised in Romanian orphanages (Gunnar & Vazquez, 2001) and other chronically stressful environments, such as being an ethnic minority (DeSantis et al, 2007).…”