Een nieuwe rol voor stressfysiologie bij functionele lichamelijke klachten

Abstract

The essential feature of functional somatic syndromes is the presence of symptoms without medical explanation. the syndromes have a high psychiatric co-morbidity, and stress and anxiety are assumed to play a role, at least in the maintenance of the complaints. Psychophysiological models traditionally attribute the symptoms to stress or anxiety-related disregulations in specific physiological mechanisms. In fact, however, there is no convincing empirical proof for such models. The idea of a direct coupling between self-reported symptoms and corresponding physiological disregulations thus seems hardly tenable. Therefore, we propose a reformulation of the potential role of stress physiology in diagnosing functional somatic symptoms. Physiological measures should not be used anymore to demonstrate explanatory physiological disregulations. They should instead be used to provide additional information about the state of activity of the central fear network . This alternative approach is based on the fact that self-reported and physiological manifestations of an emotional state are only loosely coupled, making both aspects complementary indicators of the brain activity involved. Physiological measures may thus provide additional information (above self-report) regarding emotional states implicated in functional complaints. A suggested application of this approach is to define sub-groups of functional somatic patients on the basis of similarities in disregulated physiological stress-response profiles. This in future may contribute to the development of more specific diagnostic tools and better tailored treatments.