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Clusters of medically unexplained physical symptoms have been referred to in the literature by many different labels, including somatization, symptom-based conditions, and functional somatic syndromes, among many others. The traditional medical perspective has been to classify and study these symptoms and functional syndromes separately. In psychiatry, current taxonomies (Diagnostic and Statistical Manual of Mental Disorder, 4th edition, and The International Statistical Classification of Diseases and Related Health Problems, 10th revision) classify these syndromes together under the rubric of somatoform disorders. In this article we approach medically unexplained physical symptoms from a psychiatric perspective and discuss the common features that unite multiple unexplained symptoms or functional somatic syndromes as a class. Included in this article is a discussion of nosological issues, clinical assessment, how these syndromes are viewed within the various medical specialties, and clinical management and treatment.
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We review the concept and importance of functional somatic symptoms and syndromes such as irritable bowel syndrome and chronic fatigue syndrome. On the basis of a literature review, we conclude that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences. Similarities are apparent in case definition, reported symptoms, and in non-symptom association such as patients' sex, outlook, and response to treatment. We conclude that the existing definitions of these syndromes in terms of specific symptoms is of limited value; instead we believe a dimensional classification is likely to be more productive.