Functional symptom
Encyclopedia
A functional symptom is a medical
symptom
in an individual which is very broadly conceived as arising from a problem in nervous system 'functioning' and not due to a structural or pathologically defined disease cause. Functional symptoms are increasingly viewed within a framework in which psychological, physiological and biological factors should be considered to be relevant.
Historically, there has often been fierce debate about whether certain problems are predominantly related to an abnormality of structure (disease) or function (abnormal nervous system functioning), and what are at one stage posited to be functional symptoms are sometimes later reclassified as organic, as investigative techniques improve.
Thus, on finding itself unable to discover effective treatments or physiological causes for symptoms, the medical profession, in explaining to itself these limitations of its own power over nature, is of course subject to a temptation to minimize the explanatory role played by the many gaps in its own current scientific understanding, and instead to grope for theories of psychosomatic aetiology to account for the physical symptoms that it cannot otherwise explain, and cannot cure. (To caricature this reasoning: "I can't cure you: you must be mad".) It is well established that psychosomatic symptoms are a real phenomenon, so this potential explanation is often plausible, not always easily refutable, and can be reassuring (at least for the doctor). Sometimes it is correct! For example symptoms associated with migraine
, epilepsy
, schizophrenia
, multiple sclerosis
, stomach ulcers, chronic fatigue syndrome
, Lyme disease
and many other conditions have all tended historically at first to be explained largely as physical manifestations of the sufferer's psychological state of mind; until such time as new physiological knowledge is eventually gained. At this point, a part of the earlier reliance on psychological explanations often evaporates. Taking a long, historical view, doctors being human, there seems little reason to suppose that this historical pattern of eventual correction of earlier psychological misattribution of symptoms is yet become a thing of the past.
Another specific example is functional constipation
, which may have psychological or psychiatric causes. However, one type of apparently functional constipation, anismus
, may have a neurological (physical) basis.
Whilst misdiagnosis of functional symptoms does occur, in neurology, for example, this appears to occur no more frequently than of other neurological or psychiatric syndromes. Although, in order to be quantified, misdiagnosis has to be recognized as such, which can be problematic in such a challenging field as medicine.
A common trend is to see functional symptoms and syndromes such as fibromyalgia
, irritable bowel syndrome
and functional neurological symptoms such as functional weakness
as symptoms in which both biological and psychological factors are relevant, without one necessarily being dominant.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
in an individual which is very broadly conceived as arising from a problem in nervous system 'functioning' and not due to a structural or pathologically defined disease cause. Functional symptoms are increasingly viewed within a framework in which psychological, physiological and biological factors should be considered to be relevant.
Historically, there has often been fierce debate about whether certain problems are predominantly related to an abnormality of structure (disease) or function (abnormal nervous system functioning), and what are at one stage posited to be functional symptoms are sometimes later reclassified as organic, as investigative techniques improve.
Thus, on finding itself unable to discover effective treatments or physiological causes for symptoms, the medical profession, in explaining to itself these limitations of its own power over nature, is of course subject to a temptation to minimize the explanatory role played by the many gaps in its own current scientific understanding, and instead to grope for theories of psychosomatic aetiology to account for the physical symptoms that it cannot otherwise explain, and cannot cure. (To caricature this reasoning: "I can't cure you: you must be mad".) It is well established that psychosomatic symptoms are a real phenomenon, so this potential explanation is often plausible, not always easily refutable, and can be reassuring (at least for the doctor). Sometimes it is correct! For example symptoms associated with migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, stomach ulcers, chronic fatigue syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...
, Lyme disease
Lyme disease
Lyme disease, or Lyme borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii cause most...
and many other conditions have all tended historically at first to be explained largely as physical manifestations of the sufferer's psychological state of mind; until such time as new physiological knowledge is eventually gained. At this point, a part of the earlier reliance on psychological explanations often evaporates. Taking a long, historical view, doctors being human, there seems little reason to suppose that this historical pattern of eventual correction of earlier psychological misattribution of symptoms is yet become a thing of the past.
Another specific example is functional constipation
Functional constipation
Functional constipation, known as chronic idiopathic constipation , is constipation that does not have a physical or physiological cause. It may have a neurological, psychological or psychosomatic cause...
, which may have psychological or psychiatric causes. However, one type of apparently functional constipation, anismus
Anismus
Anismus is a malfunction of the external anal sphincter and puborectalis muscle during defecation. Normal defecation involves relaxation of both of these muscles...
, may have a neurological (physical) basis.
Whilst misdiagnosis of functional symptoms does occur, in neurology, for example, this appears to occur no more frequently than of other neurological or psychiatric syndromes. Although, in order to be quantified, misdiagnosis has to be recognized as such, which can be problematic in such a challenging field as medicine.
A common trend is to see functional symptoms and syndromes such as fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
, irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
and functional neurological symptoms such as functional weakness
Functional weakness
Functional weakness is weakness of an arm or leg due to the nervous system not working properly. It is not caused by damage or disease of the nervous system...
as symptoms in which both biological and psychological factors are relevant, without one necessarily being dominant.
External links
- Functional somatic symptoms and syndromes
- Engagement in psychological treatment for functional neurological symptoms--Barriers and solutions
- Chronic multiple functional somatic symptoms
- Functional symptoms in inflammatory bowel disease and their potential influence in misclassification of clinical status