Environmental illness. A clinical review of 50 cases

Abstract

A review of 50 patients with a clinical ecology diagnosis of environmentally induced illness is reported. Histories were extremely heterogeneous. Eight patients had no symptoms or disease, 11 had symptoms caused by preexisting nonenvironmental disease, and 31 had multiple subjective symptoms. No consistent physical findings or laboratory abnormalities were found. Serum levels of immunoglobulins and complement, and circulating lymphocyte, B-cell, T-cell, and T-cell subset counts were not significantly abnormal. The diagnostic provocation-neutralization procedure, environmental restrictions, and dietary advice of clinical ecology produced further symptoms and fear of environmental and food contaminants. The patients with chronic multisystem complaints had characteristic symptoms of psychosomatic illness, but this study does not support the clinical ecology theory that psychosomatic illness may be an expression of food and chemical sensitivities induced by the toxic effect of environmental chemicals on the immune system.

Multiple Chemical Sensitivity: A Test of the Olfactory-Limbic Model

“…Several researchers believe that MCS is a manifestation of traditional psychiatric disorciers such as depression, anxiety and somatization disorden andior that MCS develops in individuals with predisposing psychiatric conditions (Black, Terr, 1986). Case histories, psychiatric and psychologicd measurement techniques, and medical assessments have al1 k e n used to examine psychopathology in MCS.…”

“…Terr (1986) reported that "these patients had clinicat features of hypochondriasis, somatization, conversion hysteria, anxiety, depression and obsessive behavior ... The subgroup of 3 1 patients with multiple symptoms most likely of psychological origin corresponds to the type of patient described repeatedly in the clinical ecology literature."…”

“…Davidoff and Fogarty (1 994) noted this problem to be evident in the measures used by Simon et al ( ), Brodse (1983, Schottenfeld and Cuilen (1 985), Terr (1986) and Stewart and R a s h (1985). Davidoff and Fogarty (1 994) concluded that, "given somatic symptoms usually inflate scores on tests of psychopathology, psychometric instnunents that avoid questions about somatic symptoms .... are better choices for studying psychopathology in a condition presenting with medical symptoms."…”

“…(Page 149). Although the method by which these diagnostic features were assessed was not outlined, Terr (1986) may have used the DSM-III cnteria as he references this source d e r making the above statement in the discussion.…”

“…Thus, these seven studies (Brodsky, 1983; Stewart & R a s h , 1985; Black et al, Simon et al, 1990;Schottenfei & Cuiien, 1985;Staudenrnayer et al, 1993;Terr, 1986) form a body of literature that States MCS is best understood as a f o m of psychiatric disturbance. Davidoff and Fogarty (1 994), however, reviewed the research literature on psychogenic ongins of multiple chemical sensitivity and noted several problems related to sample selection, memement, and study design.…”