Validity and diagnostic overlap of functional somatic syndrome diagnoses

Monica L van der Meulen; Martje Bos; Stephan J L Bakker; Reinold O B Gans; Judith G M Rosmalen

doi:10.1016/j.jpsychores.2024.111673

Validity and diagnostic overlap of functional somatic syndrome diagnoses

J Psychosom Res. 2024 Apr 15:181:111673. doi: 10.1016/j.jpsychores.2024.111673. Online ahead of print.

Authors

Monica L van der Meulen¹, Martje Bos², Stephan J L Bakker¹, Reinold O B Gans¹, Judith G M Rosmalen³

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands.
² University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
³ University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands. Electronic address: j.g.m.rosmalen@umcg.nl.

PMID: 38678828
DOI: 10.1016/j.jpsychores.2024.111673

Abstract

Objective: We present the first study that investigates the validity and the diagnostic overlap of the three main functional somatic syndrome (FSS) diagnoses, i.e. chronic fatigue syndrome (CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS), irrespective of help-seeking behaviour or diagnostic habits, and irrespective of differences in diagnostic thresholds for chronicity or symptom interference.

Methods: This cross-sectional analysis was performed in 89,781 participants of the general-population cohort Lifelines. Diagnostic criteria for CFS (Centers for Disease Control and Prevention), FM (American College of Rheumatology) and IBS (Rome IV) were assessed by questionnaire. Additional items were added to enable studying the effects of differences in thresholds for minimum symptom chronicity (varying from three for FM to six months for CFS and IBS), and symptom interference (required for CFS but not for FM and IBS).

Results: The diagnostic criteria were met by 3.1% for CFS, 6.6% for FM, and 5.5% for IBS participants. The number of participants that met criteria for all three diagnoses was 45 times higher than what would have been expected based on chance. After alignment of the chronicity and symptom interference criteria to circumvent differences in diagnostic thresholds, the overlap between diagnoses increased to 152 times. Furthermore, there was a similar pattern of symptom occurrence, particularly for those fulfilling diagnostic criteria for CFS and FM.

Conclusion: The diagnostic overlap of different FSS was much higher than would be expected by chance, and substantially increased when FSS were more chronic and serious in nature.

Keywords: Chronic fatigue syndrome; Diagnoses; Diagnostic overlap; Fibromyalgia; Irritable bowel syndrome.