Skip to main content
NCBI home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Aug;110(Suppl 4):597–599. doi: 10.1289/ehp.02110s4597

Environmental factors in medically unexplained symptoms and related syndromes: the evidence and the challenge.

Howard M Kipen 1, Nancy Fiedler 1
PMCID: PMC1241211  PMID: 12194892

Abstract

Symptoms, and especially those without clear underlying medical explanations, account for a large percentage of clinical encounters. Many unexplained symptoms have been organized by patients and practitioners into syndromes such as chronic fatigue syndrome, multiple chemical sensitivity, sick building syndrome, Gulf War syndrome, and the like. All these syndromes are defined solely on the basis of symptoms rather than by medical signs. Some of the above-described conditions overlap strongly with explained conditions such as asthma. The relationship of such symptoms and syndromes to environmental exposure is often sharply debated, as is the distinction between the various syndromes. This leads to problems of what type of research should be conducted and who should conduct it. It is time to develop a comprehensive research agenda to sort out nomenclature, epidemiology, and environmental causation for these conditions, moving toward comprehensive and effective public health and clinical approaches.

Full Text

The Full Text of this article is available as a PDF (495.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Black D. W., Doebbeling B. N., Voelker M. D., Clarke W. R., Woolson R. F., Barrett D. H., Schwartz D. A. Quality of life and health-services utilization in a population-based sample of military personnel reporting multiple chemical sensitivities. J Occup Environ Med. 1999 Oct;41(10):928–933. doi: 10.1097/00043764-199910000-00014. [DOI] [PubMed] [Google Scholar]
  2. Bowler R. M., Hartney C., Ngo L. H. Amnestic disturbance and posttraumatic stress disorder in the aftermath of a chemical release. Arch Clin Neuropsychol. 1998 Jul;13(5):455–471. [PubMed] [Google Scholar]
  3. Brooks S. M., Bernstein I. L., Raghuprasad P. K., Maccia C. A., Mieczkowski L. Assessment of airway hyperresponsiveness in chronic stable asthma. J Allergy Clin Immunol. 1990 Jan;85(1 Pt 1):17–26. doi: 10.1016/0091-6749(90)90216-q. [DOI] [PubMed] [Google Scholar]
  4. Buchwald D., Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049–2053. [PubMed] [Google Scholar]
  5. Clauw D. J. The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia. Med Hypotheses. 1995 May;44(5):369–378. doi: 10.1016/0306-9877(95)90263-5. [DOI] [PubMed] [Google Scholar]
  6. Dalton P. Cognitive influences on health symptoms from acute chemical exposure. Health Psychol. 1999 Nov;18(6):579–590. doi: 10.1037//0278-6133.18.6.579. [DOI] [PubMed] [Google Scholar]
  7. Escobar Javier I., Hoyos-Nervi Constanza, Gara Michael. Medically unexplained physical symptoms in medical practice: a psychiatric perspective. Environ Health Perspect. 2002 Aug;110 (Suppl 4):631–636. doi: 10.1289/ehp.02110s4631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fiedler N., Kelly-McNeil K., Mohr S., Lehrer P., Opiekun R. E., Lee C., Wainman T., Hamer R., Weisel C., Edelberg R. Controlled human exposure to methyl tertiary butyl ether in gasoline: symptoms, psychophysiologic and neurobehavioral responses of self-reported sensitive persons. Environ Health Perspect. 2000 Aug;108(8):753–763. doi: 10.1289/ehp.00108753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fiedler N., Kipen H. M., DeLuca J., Kelly-McNeil K., Natelson B. A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome. Psychosom Med. 1996 Jan-Feb;58(1):38–49. doi: 10.1097/00006842-199601000-00007. [DOI] [PubMed] [Google Scholar]
  10. Fiedler N., Kipen H. Chemical sensitivity: the scientific literature. Environ Health Perspect. 1997 Mar;105 (Suppl 2):409–415. doi: 10.1289/ehp.97105s2409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fukuda K., Nisenbaum R., Stewart G., Thompson W. W., Robin L., Washko R. M., Noah D. L., Barrett D. H., Randall B., Herwaldt B. L. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA. 1998 Sep 16;280(11):981–988. doi: 10.1001/jama.280.11.981. [DOI] [PubMed] [Google Scholar]
  12. Graveling R. A., Pilkington A., George J. P., Butler M. P., Tannahill S. N. A review of multiple chemical sensitivity. Occup Environ Med. 1999 Feb;56(2):73–85. doi: 10.1136/oem.56.2.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hodgson M. J., Kipen H. M. Gulf War illnesses: causation and treatment. J Occup Environ Med. 1999 Jun;41(6):443–452. doi: 10.1097/00043764-199906000-00010. [DOI] [PubMed] [Google Scholar]
  14. Hotopf M., David A., Hull L., Ismail K., Unwin C., Wessely S. Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study. BMJ. 2000 May 20;320(7246):1363–1367. doi: 10.1136/bmj.320.7246.1363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Johnson S. K., DeLuca J., Natelson B. H. Assessing somatization disorder in the chronic fatigue syndrome. Psychosom Med. 1996 Jan-Feb;58(1):50–57. doi: 10.1097/00006842-199601000-00008. [DOI] [PubMed] [Google Scholar]
  16. Kandel E. R. A new intellectual framework for psychiatry. Am J Psychiatry. 1998 Apr;155(4):457–469. doi: 10.1176/ajp.155.4.457. [DOI] [PubMed] [Google Scholar]
  17. Kipen H. M., Hallman W., Kang H., Fiedler N., Natelson B. H. Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans. Arch Environ Health. 1999 Sep-Oct;54(5):313–318. doi: 10.1080/00039899909602493. [DOI] [PubMed] [Google Scholar]
  18. Kipen H. M., Hallman W., Kelly-McNeil K., Fiedler N. Measuring chemical sensitivity prevalence: a questionnaire for population studies. Am J Public Health. 1995 Apr;85(4):574–577. doi: 10.2105/ajph.85.4.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kipen Howard M., Fiedler Nancy. The role of environmental factors in medically unexplained symptoms and related syndromes: conference summary and recommendations. Environ Health Perspect. 2002 Aug;110 (Suppl 4):591–595. doi: 10.1289/ehp.02110s4591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kreutzer R., Neutra R. R., Lashuay N. Prevalence of people reporting sensitivities to chemicals in a population-based survey. Am J Epidemiol. 1999 Jul 1;150(1):1–12. doi: 10.1093/oxfordjournals.aje.a009908. [DOI] [PubMed] [Google Scholar]
  21. Kroenke K., Mangelsdorff A. D. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989 Mar;86(3):262–266. doi: 10.1016/0002-9343(89)90293-3. [DOI] [PubMed] [Google Scholar]
  22. Kroenke K., Spitzer R. L., Williams J. B., Linzer M., Hahn S. R., deGruy F. V., 3rd, Brody D. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994 Sep;3(9):774–779. doi: 10.1001/archfami.3.9.774. [DOI] [PubMed] [Google Scholar]
  23. Lipscomb J. A., Goldman L. R., Satin K. P., Smith D. F., Vance W. A., Neutra R. R. A follow-up study of the community near the McColl waste disposal site. Environ Health Perspect. 1991 Aug;94:15–24. doi: 10.1289/ehp.94-1567957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Meggs W. J., Dunn K. A., Bloch R. M., Goodman P. E., Davidoff A. L. Prevalence and nature of allergy and chemical sensitivity in a general population. Arch Environ Health. 1996 Jul-Aug;51(4):275–282. doi: 10.1080/00039896.1996.9936026. [DOI] [PubMed] [Google Scholar]
  25. Milton D. K., Glencross P. M., Walters M. D. Risk of sick leave associated with outdoor air supply rate, humidification, and occupant complaints. Indoor Air. 2000 Dec;10(4):212–221. doi: 10.1034/j.1600-0668.2000.010004212.x. [DOI] [PubMed] [Google Scholar]
  26. Neutra R., Lipscomb J., Satin K., Shusterman D. Hypotheses to explain the higher symptom rates observed around hazardous waste sites. Environ Health Perspect. 1991 Aug;94:31–38. doi: 10.1289/ehp.94-1567952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Proctor S. P., Heeren T., White R. F., Wolfe J., Borgos M. S., Davis J. D., Pepper L., Clapp R., Sutker P. B., Vasterling J. J. Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress. Int J Epidemiol. 1998 Dec;27(6):1000–1010. doi: 10.1093/ije/27.6.1000. [DOI] [PubMed] [Google Scholar]
  28. Shusterman D., Lipscomb J., Neutra R., Satin K. Symptom prevalence and odor-worry interaction near hazardous waste sites. Environ Health Perspect. 1991 Aug;94:25–30. doi: 10.1289/ehp.94-1567940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Simon G. E., Daniell W., Stockbridge H., Claypoole K., Rosenstock L. Immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. A controlled study. Ann Intern Med. 1993 Jul 15;119(2):97–103. doi: 10.7326/0003-4819-119-2-199307150-00001. [DOI] [PubMed] [Google Scholar]
  30. Sparks P. J., Daniell W., Black D. W., Kipen H. M., Altman L. C., Simon G. E., Terr A. I. Multiple chemical sensitivity syndrome: a clinical perspective. I. Case definition, theories of pathogenesis, and research needs. J Occup Med. 1994 Jul;36(7):718–730. [PubMed] [Google Scholar]
  31. Spurgeon A., Gompertz D., Harrington J. M. Modifiers of non-specific symptoms in occupational and environmental syndromes. Occup Environ Med. 1996 Jun;53(6):361–366. doi: 10.1136/oem.53.6.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Unwin C., Blatchley N., Coker W., Ferry S., Hotopf M., Hull L., Ismail K., Palmer I., David A., Wessely S. Health of UK servicemen who served in Persian Gulf War. Lancet. 1999 Jan 16;353(9148):169–178. doi: 10.1016/S0140-6736(98)11338-7. [DOI] [PubMed] [Google Scholar]
  33. Wargocki P., Wyon D. P., Sundell J., Clausen G., Fanger P. O. The effects of outdoor air supply rate in an office on perceived air quality, sick building syndrome (SBS) symptoms and productivity. Indoor Air. 2000 Dec;10(4):222–236. doi: 10.1034/j.1600-0668.2000.010004222.x. [DOI] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES