Psychological features of subjects with idiopathic environmental intolerance

Poonai, Naveen; Antony, Martin M.; Binkley, Karen; Stenn, Peter; Swinson, Richard P.; Corey, Paul; Silverman, Frances; Tarlo, Susan M.

doi:10.1016/s0022-3999(01)00250-1

Cited by 22 publications

(12 citation statements)

References 20 publications

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“…Intubation, certain anaesthetics, GER and various other aetiologies have been implicated in inducing laryngospasm [17,29,44]. Finally, there are functional disorders that must be distinguished from VCD, including spasmodic or muscle tension dysphonia, panic attacks, Munchausen's syndrome [45] and multiple chemical sensitivity (idiopathic environmental intolerance) [46][47][48] and somatoform disorders [49].…”

Section: Differential Diagnosismentioning

confidence: 99%

Vocal cord dysfunction: what do we know?

Kenn

Balkissoon²

2010

European Respiratory Journal

142

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Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial. The essential pathophysiology is that of a hyperfunctional laryngeal reflex to protect the lower airway as a result of any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux and/or psychological conditions. Laryngoscopic demonstration of the paradoxical motion while wheezing or stridorous is considered the diagnostic gold standard. Speech therapy, including the use of special relaxed-throat breathing patterns is effective for VCD that is purely of the functional nature. Knowledge of the clinical features of VCD and identifying factors that may be contributing to the development of VCD can provide adequate clues to the correct diagnosis and management.

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Section: Differential Diagnosismentioning

confidence: 99%

Vocal cord dysfunction: what do we know?

Kenn

Balkissoon²

2010

European Respiratory Journal

142

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“…Third, several studies documented that IEI patients overlap with somatoform disorders with regard to symptoms and also psychological factors underlying somatic symptom perception and symptom report. These factors include increased trait anxiety, negative affectivity, anxiety sensitivity, agoraphobic cognitions, elevated attentional focus on bodily complaints, and heightened hysteria and hypochondriasis scores (Bailer et al, 2004b(Bailer et al, , 2005(Bailer et al, , 2006c(Bailer et al, , 2007aCaccappolo-van Vliet et al, 2002;Fiedler et al, 1996;Staudenmayer & Phillips, 2007;Poonai et al, 2001;Papo et al, 2006;Witthöft et al, 2006). In a companion article (Witthöft et al, this issue), evidence is presented that the personality trait of absorption, which is related to suggestibility, openness to experience, and fantasy proneness, may also contribute to the development of somatoform symptoms, particularly in the case of IEI.…”

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confidence: 99%

Psychological Predictors of Short- and Medium Term Outcome in Individuals with Idiopathic Environmental Intolerance (IEI) and Individuals with Somatoform Disorders

Bailer¹,

Witthöft²,

Rist

2008

Journal of Toxicology and Environmental Health, Part A

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Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity (MCS), is defined as a chronic polysymptomatic condition that cannot be explained by an organic disease. Previous studies suggest that IEI may be a variant of somatoform disorders (SFD), because both disorders overlap with respect to symptoms and psychological features of somatization. However, little is known about the short- and medium-term outcome of IEI and psychological outcome predictors. Two clinical groups (IEI and SFD) and a comparison group (CG) were followed through 32 mo to assess both the outcome, and the extent to which trait anxiety and somatic symptom attribution (assessed at first examination) predict outcome presented 12 and 32 mo later. Outcome measures were the number of self-reported IEI symptoms, IEI triggers, IEI-associated functional impairments, and the number of somatoform symptoms. In addition, the course of the 2 syndromes over the 32-mo follow-up period was investigated with standardized screening scales. The 3 diagnostic groups consisted of 46 subjects with IEI, 38 subjects with SFD but without IEI, and 46 subjects (CG) with neither IEI nor SFD. Syndrome stability was high over the 32-mo follow-up period, and at both follow-ups IEI and non-IEI subjects differed on all IEI outcome measures (symptoms, triggers, functional impairments). Both trait anxiety and somatic attribution (the tendency to attribute common somatic complaints to an illness) predicted outcome. In addition, somatic attribution was found to partially mediate the effect of trait anxiety on outcome in the IEI group. In conclusion, these results suggest that IEI is a chronic and disabling condition and that trait anxiety contributes to the maintenance of the disorder via somatic attributions.

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“…The IEI subjects in this study also scored significantly higher than controls on other self-completed questionnaires for anxiety and agoraphobia (24). These included the Mobility Inventory for Agoraphobia (MI), a self-report questionnaire in which individuals rate the extent to which they avoid 26 common agoraphobic situations when they are alone (MI-Alone) and when accompanied (MI-Accompanied) (25,26).…”

Section: Panic Responses In Idiopathic Environmental Intolerancementioning

confidence: 79%

“…They also scored significantly higher on anxiety and stress subscales of the Depression Anxiety Stress Scales (DASS) (24), a self-report questionnaire designed to measure dysphoric mood (depression subscale), symptoms of fear and autonomic arousal (anxiety subscale), and symptoms of general nervousness and agitation (stress subscale) (28,29). IEI subjects scored higher than controls on the depression subscale of the DASS as well, a difference that was marginally significant (24). The 22 IEI subjects who fulfilled panic attack criteria after 35% CO 2 inhalation had significantly higher scores than IEI subjects who did not panic on the MIAlone component of the MI, as well as the depression subscale of the DASS.…”

Section: Panic Responses In Idiopathic Environmental Intolerancementioning

confidence: 99%

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Tarlo

Poonai

Binkley

et al. 2002

Environ Health Perspect

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Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

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Psychological features of subjects with idiopathic environmental intolerance

Cited by 22 publications

References 20 publications

Vocal cord dysfunction: what do we know?

Vocal cord dysfunction: what do we know?

Psychological Predictors of Short- and Medium Term Outcome in Individuals with Idiopathic Environmental Intolerance (IEI) and Individuals with Somatoform Disorders

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

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