Stress as a Pathophysiological Factor in Functional Somatic Syndromes

Abstract

Functional somatic syndromes (FSS) are defined by a constellation of symptoms for which after thorough medical examination no structural pathology and no proportional tissue abnormalities can be identified. Pathophysiology of these syndromes has remained elusive and treatment options are limited. Current research efforts acknowledge the importance of stress as a potential risk factor in the manifestation and maintenance of FSS. A substantial body of research has focused on psychological stress factors as well as alterations of the endocrine stress system (the hypothalamicpituitary-adrenal, HPA axis, in particular), the immune system, and the autonomic nervous system (ANS). Dysregulation of these systems might explain some of the symptoms of FSS. In this review, we describe studies reporting stress-related findings in three of the most prevalent and well-described FSS, i.e. chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and fibromyalgia syndrome (FMS). Psychobiological processes which seem to play a role in the translation of stress into functional symptoms and syndromes are discussed.

Sociodemographic, lifestyle, and psychosocial determinants of hair cortisol in a South London community sample

“…There is ever-increasing evidence for the long-lasting ramifications of early life adversity and chronic psychosocial stress via epigenetic modification of genes involved in HPA axis regulation (Lupien et al, 2009). It is therefore not surprising that the presence of psychosocial stressors, such as childhood trauma and critical life events, is frequently associated with dysregulations of the HPA axis, which in turn may predispose an individual to develop stress-related disorders, such as depression or somatoform disorders (Heim and Nemeroff, 2001;Nater et al, 2011). Hypothalamicpituitary-adrenal measures have therefore become crucial parameters for research looking into stress and the pathophysiology of stress-related disorders.…”

Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome—The role of cortisol and alpha-amylase

“…In the past, a case has been made that stress may be an important perpetuating factor in FMS (Nater et al, 2011). As far as empirical evidence is concerned, a plethora of cross-sectional studies have used questionnaires measuring chronic stress or daily hassles in patients with FMS.…”

Negative Stress Beliefs Predict Somatic Symptoms in Students Under Academic Stress

“…While medical diseases account for many somatic symptoms, there is a surprisingly large proportion of patients [over 35 %; 2, 3] whose complaints remain “medically unexplained.” The last decades have witnessed a shift towards a multi-factorial explanation of medically unexplained symptoms. One of the most frequently discussed pathogenic factors is stress, as it has been found to be involved in the predisposition, precipitation, and perpetuation of numerous medically unexplained conditions, such as chronic fatigue syndrome or fibromyalgia syndrome [4]. …”