Somatization and fashionable diagnoses: illness as a way of life

The history of "nondisease" dates back, at least 4000 years, to early descriptions of hysteria. More recently somatization became a part of the official diagnostic nomenclature by creation of the DSM III category, "somatoform disorders." Somatization can serve as a rationalization for psychosocial problems or as a coping mechanism, and for some illness, becomes a way of life. One variation of somatization can be the "fashionable diagnosis", for example, fibromyalgia, multiple chemical sensitivities, dysautonomia, and, in the past, "reactive hypoglycemia". These disorders are phenomenologically related to environmental or occupational syndromes and mass psychogenic illness. Fashionable illnesses are characterized by (i) vague, subjective multisystem complaints, (ii) a lack of objective laboratory findings, (iii) quasi-scientific explanations, (iv) overlap from one fashionable diagnosis to another, (v) symptoms consistent with depression or anxiety or both, (vi) denial of psychosocial distress or attribution of it to the illness. Fashionable diagnoses represent a heterogeneous collection of physical diseases, somatization, and anxiety or depression. They are final common symptomatic pathways for a variety of influences including environmental factors, intrapersonal distress and solutions to social problems. A fashionable diagnosis allows psychosocial distress to be comfortably hidden from both the patient and the physician, but premature labeling can also mask significant physical disease. Hysteria remains alive and well and one contemporary hiding place is fashionable illness.