Sixty-three patients with polysomatic complaints
attributed to sensitivity to environmental
chemicals had detailed clinical assessments and
diagnostic psychologic evaluations. Objective
medical parameters failed to substantiate their
beliefs that multiple chemicals were the cause of
their problems. A group of 64 patients with chronic
medical conditions and defined psychologic
disorders not attributed to chemical exposure
served as controls. Approximately half the patients
in each group underwent long-term psychotherapy,
and in these patients, the prevalence of
physical and sexual childhood abuse was significantly
higher (P < .05) among the cohort of
women who attributed their symptoms to environmental
or chemically related illness. These data
suggest that somatization may reflect sequelae of
childhood abuse and may play an important role
in the illness experienced by women who believe
they are sensitive to environmental chemicals.

To date, relatively little is known about the
etiology, pathophysiology, diagnosis, therapy,
prevention and prognosis of environment-related
syndromes like multiple chemical sensitivity
(MCS), idiopathic environmental intolerance (IEI),
sick building syndrome (SBS), chronic fatigue
syndrome (CFS), candida syndrome (CS) and
burnout syndrome (BS). Part of the reason is that
these syndromes have not been clearly defined
and classified in scientific categories distinct from
each other, and that they show clinical similarities
to classified somatoform disorders.
Furthermore, there are at least three possible
explanations for the existence of these syndromes:
(1) The syndromes may result from the interaction
of environmental factors, individual
susceptibility and psychological factors (i.e., how
they are perceived and seen by the patient); (2)
they may reflect socially and culturally accepted
methods of expressing distress; and/or (3) they
may be iatrogenic. Despite all the uncertainties
in evaluation of environmental syndromes,
physicians have the duty to take the affected
person’s problems seriously. A comprehensive
systematic classification which better accounts
for these complex clinical manifestations is long
overdue. Until these syndromes are well defined,
the terms used for them should definitely not be
applied to connote a specific disease process.

BACKGROUND: Physical symptoms are
commonly presented for treatment in the absence of
physical pathology. This study tests predictions
arising from the theory that childhood sexual
abuse leads to emotional distress, illness orientation
and social dysfunction as adults and that one
or more of these effects, in turn, leads to presentation
of functional (i.e. unexplained) symptoms.

METHODS: Two groups of patients with physical
symptoms in the absence of organic disease
(non-epileptic attack disorder or irritable bowel
syndrome) were contrasted with organically
diseased groups with comparable symptoms
(epilepsy and Crohn’s disease, respectively).

RESULTS: Despite their contrasting clinical presentation,
irritable bowel and non-epileptic attack
groups were similar in recalling more sexual and
physical abuse, as both children and adults, than
their comparison groups. They were also similar
in being more emotionally and socially disturbed
and illness-orientated, but these putative mediating
variables could not account for the relationship
of abuse with presentation of functional symptoms.

CONCLUSIONS: Adults presenting
functional neurological and abdominal symptoms
are characterized by history of abuse. The
current focus on childhood sexual abuse should
be broadened to include sexual, and particularly
physical, abuse in adulthood as well as childhood.
The intervening processes that link abuse to
somatization remain to be identified but are
unlikely to include adult emotional and social
disturbance or general illness-orientation.

BACKGROUND: An increasing number of
individuals with diverse health complaints are
currently seeking help in the field of environmental
medicine. Multiple chemical sensitivity (MCS)
or idiopathic environmental intolerances (IEI)
is defined as an acquired disorder with multiple
recurrent symptoms associated with environmental
chemicals in low concentrations that are well
tolerated by the majority of people. Their symptoms
are not explained by any known psychiatric
or somatic disorder.

METHOD: Within a 2-year period we
examined 264 of 267 consecutive
patients prospectively presenting to a university
based out-patient department for environmental
medicine. Patients underwent routine medical
examination, toxicological analysis and the
structured clinical interview for DSM-IV
psychiatric disorders (SCID).

RESULTS: Seventy-five per cent of the patients
met DSM-IV criteria for at least one psychiatric
disorder and 35% of all patients suffered from
somatoform disorders. Other frequent diagnoses
were affective and anxiety disorders, and
dependence or substance abuse. In 39%
a psychiatric disorder, in 23% a somatic
condition and in 19% a combination of the two
were considered to provide sufficient
explanation of the symptoms. Toxic chemicals
were regarded as the most probable cause in only
five cases. The suspected diagnosis of MCS/IEI
could not be sustained in the vast majority of cases.

CONCLUSION: This investigation confirms
previous findings that psychiatric morbidity is
high in patients presenting to specialized centres
for environmental medicine. Somatoform
disorders are the leading diagnostic category,
and there is reason to believe that certain
‘environmental’ or MCS patients form a special
subgroup of somatoform disorders. In most
cases, symptoms can be explained by well-defined
psychiatric and medical conditions other than
MCS, which need specific treatment. Further
studies should focus on provocation testing in order
to find positive criteria for MCS and on therapeutic
approaches that consider psychiatric aspects.

Bell IR, Baldwin CM, Russek LG, Schwartz GE,
Hardin EE. Department of Psychiatry, University of
Arizona, Tucson, USA.

This study (ntotal = 35) compared early life
stress ratings, parental relationships, and health
status, notably orthostatic blood pressures, of
middle-aged women with low-level chemical
intolerance (CI group) and depression,
depressives without CI (DEP group), and normals.
Environmental chemical intolerance is a symptom
of several controversial conditions in which
women are overrepresented, that is, sick building
syndrome, multiple chemical sensitivity, chronic
fatigue syndrome, and fibromyalgia. Previous
investigators have postulated that people with CI
have variants of somatization disorder, depression,
posttraumatic stress disorder (PTSD) initiated
by childhood abuse or a toxic exposure event.
One neurobehavioral model for CI, somatization
disorder, recurrent depression, and PTSD is
neural sensitization, that is, the progressive
amplification of host responses (e.g., behavioral,
neurochemical) to repeated intermittent stimuli
(e.g., drugs, chemicals, endogenous mediators,
stressors). Females are more vulnerable to
sensitization than are males. Limbic and mesolimbic
pathways mediate central nervous system
sensitization. Although both CI and DEP groups
had high levels of life stress and past abuse, the
CI group had the most distant and weak paternal
relationships and highest limbic somatic
dysfunction subscale scores. Only the CI group
showed sensitization of sitting blood pressures
over sessions. Together with prior evidence,
these data are consistent with a neural sensitization
model for CI in certain women. The findings
may have implications for poorer long-term medical
as well as neuropsychiatric health outcomes
of a subset of women with CI. Subsequent research
should test this model in specific clinical diagnostic
groups with CI.

BACKGROUND: An increasing number of
individuals with diverse health complaints are
currently seeking help in the field of environmental
medicine. Multiple chemical sensitivity (MCS)
or idiopathic environmental intolerances (IEI)
is defined as an acquired disorder with multiple
recurrent symptoms associated with environmental
chemicals in low concentrations that are well
tolerated by the majority of people. Their symptoms
are not explained by any known psychiatric
or somatic disorder.

METHOD: Within a 2-year period we
examined 264 of 267 consecutive
patients prospectively presenting to a university
based out-patient department for environmental
medicine. Patients underwent routine medical
examination, toxicological analysis and the
structured clinical interview for DSM-IV
psychiatric disorders (SCID).

RESULTS: Seventy-five per cent of the patients
met DSM-IV criteria for at least one psychiatric
disorder and 35% of all patients suffered from
somatoform disorders. Other frequent diagnoses
were affective and anxiety disorders, and
dependence or substance abuse. In 39%
a psychiatric disorder, in 23% a somatic
condition and in 19% a combination of the two
were considered to provide sufficient
explanation of the symptoms. Toxic chemicals
were regarded as the most probable cause in only
five cases. The suspected diagnosis of MCS/IEI
could not be sustained in the vast majority of cases.

CONCLUSION: This investigation confirms
previous findings that psychiatric morbidity is
high in patients presenting to specialized centres
for environmental medicine. Somatoform
disorders are the leading diagnostic category,
and there is reason to believe that certain
‘environmental’ or MCS patients form a special
subgroup of somatoform disorders. In most
cases, symptoms can be explained by well-defined
psychiatric and medical conditions other than
MCS, which need specific treatment. Further
studies should focus on provocation testing in order
to find positive criteria for MCS and on therapeutic
approaches that consider psychiatric aspects.

BACKGROUND: A nationwide, environmental outpatient-based
multi-center two-phase study on Multiple Chemical
Sensitivity (MCS) was conducted from 1999 until 2004.
The aim of the study was to characterize more precisely
the health-complaints relevant for the MCS-phenomenon.
A standardized psychiatric interview (CIDI), used to
identify frequency, character and duration of psychiatric
disorders and their chronological relation to the
environment-related health complaints of the patients,
formed part of the extensive diagnostic procedure.

METHOD: 251 (86.3%) of the 291 attendees of the
environmental outpatient departments in Aachen, Berlin,
Bredstedt, Freiburg, Giessen and Munich, were examined
using the German version (M-CIDI/DIA-X) of the Composite
International Diagnostic Interview.

RESULTS: 83.7% (lifetime prevalence rate) fulfilled the
diagnostic criteria of at least one psychiatric disorder,
with the 12-month and 4-week prevalence rates being
76.5% and 64.5%, respectively. Environmental outpatients,
in all prevalence periods, had significantly higher rates
of psychiatric disorders than the comparable general
population. Somatoform disorders were most frequently
diagnosed, followed by depressive and phobic disorders.
For 81.2% of the patients the psychiatric disorder
started long before the environment-related health
complaints (average 17 years).

CONCLUSIONS: This study confirms the results of earlier
studies, i.e. that patients with environment-related
health complaints suffer from psychiatric disorders
more frequently than the general population. The high
environmental outpatients really suffer from
psychosomatic complaints, but attribute the causes to
the environment. Application of specific therapeutic
regimen is recommended for those patients, whose
psychiatric disorders are safeguarded diagnostically
and for whom a relevant exposure is unlikely.

OBJECTIVE: To understand idiopathic environmental
intolerances (IEI)-formerly multiple chemical
sensitivities (MCS)-it is helpful to outline its
characteristic psychiatric morbidity.

METHOD: We applied a standardized interview
according to the Diagnostic and Statistical Manual
of Mental Disorders, 4th Edition (SCID) to 305
environmental patients with and without IEI.

RESULTS: Somatoform, affective and anxiety
disorders were the most frequent diagnoses but
only slightly differed between patients with or
without IEI. In both groups, current
substance-related disorders were rare. We found
a clearly higher prevalence of psychotic,
especially current delusional disorders, in IEI.

CONCLUSION: Somatization, depression, and anxiety
are frequent in IEI but nonspecific. Psychotic
disorders are more common in IEI than in other
types of environmental illness. It appears
worthwhile to study personality and cognitive
style to explain the pivotal features of IEI.

www.BreastImplantAwareness.org/QuackWatchWatch.htm

    * Video: ‘Skin-Eating’ Mystery Disease Reported In Florida; CDC
Investigates

The illness is called Morgellons and Florida, Texas and California are
states with apparent hot spots for the condition, Local 6 reported.

People who report suffering from the condition identify a range of
symptoms including vision loss, mental confusion and fatigue. Some
sufferers also said they have experienced tiny fibers that pop out of
their skin.

"They typically describe a disturbing skin sensation such as itching
or stinging or pins and needles," Centers for Disease Control Dr.
Michele Pearson said.

Last summer, registered nurse Cindy Casey said the constant lesions on
her body forced her to quit working.

"It’s miserable," Casey said. "It feels like you’ve got splinters
coming out."

Thousands of people claim to have Morgellons and a foundation has been
formed.

However, some are not certain Morgellons is a legitimate disease.

"The reason we are doing an investigation is to learn more about it,"
Pearson said.

Researchers plan to follow up with 500 people who claim to have the
condition.

Volunteers will get blood tests, skin exams as well as psychological
evaluations.

Doctors at Oklahoma State University have been studying Morgellons for
years and said they don’t know what’s causing it.

The CDC’s year-long study will try to figure out what’s causing
Morgellons and if there’s any way to treat it.