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Idiopathic Environmental Intolerance

Part 2: A Causation Analysis Applying Bradford Hill’s Criteria to the Psychogenic Theory

Abstract

Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill’s criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies. We conclude that IEI is a belief characterised by an overvalued idea of toxic attribution of symptoms and disability, fulfilling criteria for a somatoform disorder and a functional somatic syndrome. A neurobiological diathesis similar to anxiety, specifically panic disorder, is a neurobiologically plausible mechanism to explain triggered reactions to ambient doses of environmental agents, real or perceived. In addition, there is a cognitively mediated fear response mechanism characterised by vigilance for perceived exposures and bodily sensations that are subsequently amplified in the process of learned sensitivity. Implications for the assessment and treatment of patients are presented.

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Table I
Table II

References

  1. 1.

    Staudenmayer H, Binkley KE, Leznoff A, et al. Idiopathic environmental intolerance: part 1 — a causation analysis applying Bradford Hill’s criteria to the toxicogenic theory. Toxicol Rev 2003; 22(3): 235–46

  2. 2.

    McKenna PJ. Disorders with overvalued ideas. Br J Psychiatry 1984; 145: 579–85

  3. 3.

    Ross SE. ‘Memes’ as infectious agents in psychosomatic illness. Ann Intern Med 1999; 131: 867–71

  4. 4.

    Staudenmayer H. Environmental illness: myth and reality. Boca Raton (FL): CRC/Lewis Publishers, 1999

  5. 5.

    Staudenmayer H. Idiopathic environmental intolerances (IEI): myth and reality. Toxicol Lett 2001; 120: 333–42

  6. 6.

    Black DW. The relationship of mental disorders and idiopathic environmental intolerance. Occup Med 2000; 15: 557–70

  7. 7.

    Sparks PJ. Idiopathic environmental intolerances: overview. Occup Med 2000; 15: 497–510

  8. 8.

    Bornschein S, Forstl H, Zilker T. Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives. J Intern Med 2001; 250: 309–21

  9. 9.

    Gothe CJ, Molin CM, Nilsson CG. The environmental somatization syndrome. Psychosomatics 1995; 36: 1–11

  10. 10.

    Boss LP. Epidemic hysteria: a review of the published literature. Epidemiol Rev 1997; 19: 232–43

  11. 11.

    Bartholomew RE, Wessely S. Protean nature of mass sociogenic illness. Br J Psychiatry 2002; 180: 300–4

  12. 12.

    Dodes JE. The amalgam controversy: an evidence-based analysis. J Am Dent Assoc 2001; 132: 348–56

  13. 13.

    Selner JC, Staudenmayer H. Food allergy: psychological considerations. In: Metcalfe DD, Sampson HA, Simon RA, editors. Food allergy: adverse reactions to foods and food additives. 2nd ed. Cambridge (MA): Blackwell Science, 1997: 519–28

  14. 14.

    Staudenmayer H, Selner JC. Psychological manifestations in idiopathic environmental intolerance (foods). In: Frieri M, Kettelhut B, editors. Food hypersensitivity and adverse reactions. New York: Marcel Dekker, 1999: 347–80

  15. 15.

    Levallois P. Hypersensitivity of human subjects to environmental electric and magnetic field exposure: a review of the literature. Environ Health Perspect 2002; 110Suppl. 4: 613–8

  16. 16.

    Tarlo SM, Poonai N, Binkley K. Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder. Environ Health Perspect 2002; 110Suppl. 4: 669–71

  17. 17.

    Meggs WJ. RADS and RUDS: the toxic induction of asthma and rhinitis. Clin Toxicol 1994; 32: 487–501

  18. 18.

    Bell IR, Hardin EE, Baldwin CM, et al. Increased limbic system symptomatology and sensitizability of young adults with chemical and noise sensitivities. Environ Res 1995; 70: 84–97

  19. 19.

    Ziem GE, Davidoff LL. Illness from chemical ‘odors’: is the health significance understood? Arch Environ Health 1992; 47: 88–91

  20. 20.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Press, 1994

  21. 21.

    Simon GE, Daniell W, Stockbridge H, et al. Immunologic, psychological and neuropsychological factors in multiple chemical sensitivity. Ann Intern Med 1993; 19: 97–103

  22. 22.

    Black DW, Rathe A, Goldstein RB. Environmental illness: a controlled study of 26 subjects with ‘20th century disease.’ JAMA 1990; 264: 3166–70

  23. 23.

    Black DW, Rathe A, Goldstein RB. Measures of distress in 26 ‘environmentally ill’ subjects. Psychosomatics 1993; 34: 131–8

  24. 24.

    Hausteiner C, Bornschein S, Bickel H, et al. Psychiatric morbidity and low selfattentiveness in patients with environmental illness. J Nerv Ment Dis 2003; 191: 50–5

  25. 25.

    Brewin CR. Cognitive theories of motivation. In: Eysenck H, Martin I, editors. Theoretical foundations of behavior therapy. New York: Plenum, 1987: 277–93

  26. 26.

    Shedler J, Mayman M, Manis M. The illusion of mental health. Am Psychol 1993; 48: 1117–31

  27. 27.

    Fiedler N, Maccia C, Kipen H. Evaluation of chemically sensitive patients. J Occup Med 1992; 34: 529–38

  28. 28.

    Staudenmayer H, Selner JC. Failure to assess psychopathology in patients presenting with chemical sensitivities. J Occup Med 1995; 37: 704–9

  29. 29.

    Terr AI. Environmental illness: a clinical review of 50 cases. Arch Intern Med 1986; 146: 145–9

  30. 30.

    Hill AB. The environment and disease: association or causation. Proc R Soc Med 1965; 58: 295–300

  31. 31.

    Hammond EC. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Public Health 1964; 54: 11–23

  32. 32.

    Simon GE, VonKorff M, Piccinelli M, et al. An international study of the relation between somatic symptoms and depression. N Engl J Med 1999; 341: 1329–35

  33. 33.

    Leznoff A. Provocative challenges in patients with multiple chemical sensitivity. J Allergy Clin Immunol 1997; 99: 438–42

  34. 34.

    Simon GE, VonKorff M. Somatization and psychiatric disorder in the NIMH epidemiologic catchment area study. Am J Psychiatry 1991; 148: 1494–500

  35. 35.

    Selner JC, Staudenmayer H. The relationship of the environment and food to allergic and psychiatric illness. In: Young SH, Rubin JM, Daman HR, editors. Psychophysiological aspects of allergic disorders. New York: Praeger, 1986: 102–46

  36. 36.

    Bornschein S, Hausteiner C, Zilker T, et al. Psychiatric and somatic disorders and multiple chemical sensitivity (MCS) in 264 ‘environmental patients’. Psychol Med 2002; 32: 1387–94

  37. 37.

    Moorhead JF, Suruda AJ. Occipital lobe meningioma in a patient with multiple chemical sensitivities. Am J Ind Med 2000; 37: 443–6

  38. 38.

    Escobar JI, Hoyos-Nervi C, Gara M. Medically unexplained physical symptoms in medical practice: a psychiatric perspective. Eniron Health Perspect 2002; 110Suppl. 4: 631–6

  39. 39.

    Bass C, Benjamin S. The management of chronic somatization. Br J Psychiatry 1993; 162: 472–80

  40. 40.

    Kellner R. Somatization theories and research. J Nerv Ment Dis 1990; 178: 150–60

  41. 41.

    Pennebaker JW. Psychological bases of symptom reporting: perceptual and emotional aspects of chemical sensitivity. Toxicol Ind Health 1994; 10: 497–511

  42. 42.

    Barsky AJ, Klerman GL. Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry 1983; 140: 273–83

  43. 43.

    Barsky AJ, Borus JF. Somatization and medicalization in the era of managed care. JAMA 1995; 274: 1931–4

  44. 44.

    Stewart DE. The changing faces of somatization. Psychosomatics 1990; 31: 153–8

  45. 45.

    Shorter E. From paralysis to fatigue: a history of psychosomatic illness in the modern era. New York: Free Press/Macmillan, 1992

  46. 46.

    Wessely S. Old wine in new bottles: neurasthenia and ‘ME’. Psychol Med 1990; 20: 35–53

  47. 47.

    Wessely S. Chronic fatigue syndrome: a 20th century illness. Scand J Work Environ Health 1997; 23Suppl. 3: 17–34

  48. 48.

    Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med 1999; 130: 910–21

  49. 49.

    Hadler NM. Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Postgrad Med 1997; 102: 161–7

  50. 50.

    Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple1 chemical sensitivities. Arch Intern Med 1994; 154: 2049–53

  51. 51.

    Rea WJ. Chemical sensitivity: clinical manifestations of pollutant overload. Vol. 3. Boca Raton (FL): Lewis Publishers/CRC Press, 1995

  52. 52.

    Schaumburg HH, Spencer PS, Ludolph AC, editors. Experimental and clinical neurotoxicology. 2nd ed. New York: Oxford University Press, 2000

  53. 53.

    Rosenberg NL, editor. Occupational and environmental neurology. Newton (MA): Butterworth-Heineman, 1995

  54. 54.

    Bardana EJ. Sick building syndrome: a wolf in sheep’s clothing. Ann Allergy Asthma Immunol 1997; 79: 283–93

  55. 55.

    Ooi PL, Goh KT. Sick building syndrome: an emerging stress-related disorder. Int J Epidemiol 1997; 26: 1243–9

  56. 56.

    Hodgson MJ. Indoor environmental exposures and symptoms. Environ Health Perspect 2002; 110Suppl. 4: 663–7

  57. 57.

    Christopher KL, Wood RP, Eckert RC, et al. Vocal-cord dysfunction presenting as asthma. N Engl J Med 1983; 308: 1566–70

  58. 58.

    Selner JC, Staudenmayer H, Koepke JW, et al. Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing. J Allergy Clin Immunol 1987; 79: 726–33

  59. 59.

    Perkner JJ, Fennelly KP, Balkissoon R, et al. Irritant-associated vocal cord dysfunction. J Occup Environ Med 1998; 40: 136–43

  60. 60.

    Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures. Chest 1985; 88: 376–84

  61. 61.

    Brooks SM, Hammad Y, Richards I, et al. The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergy. Chest 1998; 113: 42–9

  62. 62.

    Bardana EJ. Reactive airways dysfunction syndrome (RADS): guidelines for diagnosis and treatment and insight into likely prognosis. Ann Asthma Allergy Immunol 1999; 83: 583–6

  63. 63.

    Ross PM, Whysner J, Covello VT, et al. Olfaction and symptoms in multiple chemical sensitivities syndrome. Prev Med 1999; 28: 467–80

  64. 64.

    Meggs WJ. Neurogenic inflammation and sensitivity to environmental chemicals. Environ Health Perspect 1993; 101: 234–8

  65. 65.

    Demitrack MA, Abbey SE. Chronic fatigue syndrome: an interactive approach to evaluation and treatment. New York: Guilford Press, 1996

  66. 66.

    Natelson BH, Lange G. A status report on chronic fatigue syndrome. Environ Health Perspect 2002; 110Suppl. 4: 673–7

  67. 67.

    Epstein SA, Kay G, Clauw D, et al. Psychiatric disorders in patients with fibromyalgia: a multicenter investigation. Psychosomatics 1999; 40: 57–63

  68. 68.

    Winfield JB. Pain in fibromyalgia. Rheumatol Clin North Am 1999; 25: 55–79

  69. 69.

    Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990; 113:828–33

  70. 70.

    Drossman DA, McKee DC, Sandler RS, et al. Psychosocial factors in the irritable bowel syndrome: a multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 1988; 95: 701–8

  71. 71.

    Kroenke K, Koslowe P, Roy M. Symptoms in 18,495 Persian Gulf war veterans. J Occup Environ Med 1998; 40: 520–8

  72. 72.

    Roy MJ. Environmental influences on illnesses in Persian Gulf war veterans. In: Lundberg A, editor. The environment and mental health. Hillsdale (NJ): Lawrence Erlbaum, 1998: 67–82

  73. 73.

    Black DW, Doebbeling BN, Voelker MD, et al. Multiple chemical sensitivity: symptom prevalence and risk factors in a military population. Arch Intern Med 2000; 160: 1169–76

  74. 74.

    Skapinakis P, Lewis G, Venetsanos M. Unexplained fatigue syndromes in a multinational primary care sample: specificity of definition and prevalence and distinctiveness from depression and generalized anxiety. Am J Psychiatry 2003; 160: 785–7

  75. 75.

    Stewart DE, Raskin J. Psychiatric assessment of patients with ‘20th century disease’ (‘total allergy syndrome’). CMAJ 1985; 133: 1001–6

  76. 76.

    Simon GE, Katon WJ, Sparks PJ. Allergic to life: psychological factors in environmental illness. Am J Psychiatry 1990; 147: 901–6

  77. 77.

    Fiedler N, Kipen H. Chemical sensitivity: the scientific literature. Environ Health Perspect 1997; 105Suppl. 2: 409–15

  78. 78.

    Selner JC. Chamber challenges: the necessity of objective observation. Reg Toxicol Pharmacol 1996; 24: S87

  79. 79.

    Weiss B. Experimental strategies for research on multiple chemical sensitivity. Environ Health Perspect 1997; 105Suppl. 2: 487–94

  80. 80.

    International Programme on Chemical Safety/World Health Organization (IPCS/WHO). Conclusions and recommendations of a workshop on multiple chemical sensitivities (MCS). Reg Toxicol Pharmacol 1996; 24: S188

  81. 81.

    Graveling RA, Pilkington A, George JP. A review of multiple chemical sensitivity. Occup Environ Med 1999; 56: 73–85

  82. 82.

    Pearson DJ, Rix KJ, Bentley SJ. Food allergy: how much in the mind?: a clinical and psychiatric study of suspected food hypersensitivity. Lancet 1983; I(8336): 1259–61

  83. 83.

    Rix KJ, Pearson DJ, Bentley SJ. A psychiatric study of patients with supposed food allergy. Br J Psychiatry 1984; 145: 121–6

  84. 84.

    Parker SL, Leznoff A, Sussman GL, et al. Characteristics of patients with food-related complaints. J Allergy Clin Immunol 1990; 86: 503–11

  85. 85.

    Jewett DL, Fein G, Greenberg MH. A double-blind study of symptom provocation to determine food sensitivity. N Engl J Med 1990; 323: 429–33

  86. 86.

    Staudenmayer H, Selner JC, Buhr M. Double-blind provocation challenges in 20 patients presenting with ‘multiple chemical sensitivity’. Reg Toxicol Pharmacol 1993; 18: 44–53

  87. 87.

    Hummel T, Roscher S, Jaumann MP, et al. Intranasal chemoreception in patients with multiple chemical sensitivity: a double-blind investigation. Reg Toxicol Pharmacol 1996; 24: S79

  88. 88.

    Dalton P. Cognitive influences on health symptoms from acute chemical exposure. Health Psychol 1999; 18: 579–90

  89. 89.

    Dalton P, Hummel T. Chemosensory function and response in idiopathic environmental intolerance. Occup Med 2000; 15: 539–56

  90. 90.

    Andersson B, Berg M, Arnetz BB, et al. A cognitive-behavioral treatment of patients suffering from ‘electric hypersensitivity’. J Occup Environ Med 1996; 38: 752–8

  91. 91.

    Flodin U, Seneby A, Tegenfeldt C. Provocation of electrical hypersensitivity under everyday conditions. Scand J Work Environ Health 2000; 26: 93–8

  92. 92.

    Bolla-Wilson K, Wilson RJ, Bleeker ML. Conditioning of physical symptoms after neurotoxic exposure. J Occup Med 1988; 30: 684–6

  93. 93.

    Spyker DA. Multiple chemical sensitivities: syndrome and solution. Clin Toxicol 1995; 33: 95–9

  94. 94.

    Giardino ND, Lehrer PM. Behavioral conditioning and idiopathic environmental intolerance. Occup Med 2000; 15: 519–28

  95. 95.

    Sullivan Jr JB, Krieger GR. Hazardous materials toxicology: clinical principles of environmental health. Baltimore (MD): Williams & Wilkins, 1992

  96. 96.

    Binkley KE, Kutcher S. Panic response to sodium lactate infusion in patients with multiple chemical sensitivity syndrome. J Allergy Clin Immunol 1997; 99: 570–4

  97. 97.

    Poonai N, Anthony MM, Binkley KE, et al. Carbon dioxide inhalation challenges in idiopathic environmental intolerance. J Allergy Clin Immunol 2000; 105: 358–63

  98. 98.

    Sinha S, Papp LA, Gorman JM. How study of respiratory physiology aided our understanding of abnormal brain function in panic disorder. J Affect Disord 2000; 61: 191–200

  99. 99.

    Selner JC, Staudenmayer H. Neuropsychophysiologic observations in patients presenting with environmental illness. Toxicol Ind Health 1992; 8: 145–55

  100. 100.

    Rosenberg SJ, Freedman MR, Schmaling KG, et al. Personality styles of patients asserting environmental illness. J Occup Med 1990; 32: 678–81

  101. 101.

    Schmidt LA, Fox NA, Schulkin J, et al. Behavioral and psychophysiological correlates of self-presentation in temperamentally shy children. Dev Psychobiol 1999; 35: 119–35

  102. 102.

    Arbelle S, Benjamin J, Golin M, et al. Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymorphism. Am J Psychiatry 2003; 160: 671–6

  103. 103.

    Bell IR. Neuropsychiatric aspects of sensitivity to low-level chemicals: a neural sensitization model. Toxicol Ind Health 1994; 10: 277–312

  104. 104.

    Binkley K, King N, Poonai N, et al. Idiopathic environmental intolerance; Increased prevalence of panic disorder-associated cholecystokinin B receptor allele 7. J Allergy Clin Immunol 2001; 107: 887–90

  105. 105.

    Knutson JF. Physical and sexual abuse of children. In: Rauth DK, editor. Handbook of pediatric psychology. New York: Guilford, 1988: 32–70

  106. 106.

    Green AH. Physical and sexual abuse of children. In: Kaplan HI, Sadeck BI, editors. Comprehensive textbook of psychiatry. Vol 2. 5th ed. Baltimore (MD): Williams and Wilkins, 1989: 1962–70

  107. 107.

    Shengold L. Soul murder: the effects of childhood abuse and deprivation. New York: Ballantine Books, 1989

  108. 108.

    Loewenstein RJ. Somatoform disorders in victims of incest and child abuse. In: Kluft RP, editor. Incest related syndromes of adult psychopathology. Washington, DC: American Psychiatric Press, 1990: 75–111

  109. 109.

    Briere J. Medical symptoms, health risk, and history of childhood sexual abuse. Mayo Clin Proc 1992; 67: 527–32

  110. 110.

    Benjamin S, Eminson DM. Abnormal illness behavior: childhood experiences and long-term consequences. Int Rev Psychiatry 1992; 4: 55–70

  111. 111.

    Norris FH. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol 1992; 60: 409–18

  112. 112.

    Springs FE, Friedrich WN. Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clin Proc 1992; 67: 527–33

  113. 113.

    DeBellis MD, Putman FW. The psychobiology of childhood maltreatment. Child Adolesc Psychiatric Clin North Am 1994; 3: 663–78

  114. 114.

    Schwarz ED, Perry BD. The post-traumatic response in children and adolescents. Psychiatr Clin North Am 1994; 17: 311–26

  115. 115.

    Silk KR, editor. Biological and neurobehavioral studies of borderline personality disorder. Washington, DC: American Psychiatric Press, 1994

  116. 116.

    Dancu CV, Riggs DS, Hearst-Ikeda DE, et al. Dissociative experiences and posttraumatic stress disorder among female victims of criminal assault and rape. J Trauma Stress 1996; 9: 253–67

  117. 117.

    Draijer N, Langeland W. Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric patients. Am J Psychiatry 1999; 156: 379–85

  118. 118.

    Heim C, Newport DH, Heit S, et al. Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000; 284: 592–7

  119. 119.

    MacMillan HL, Fleming JE, Streiner DL, et al. Childhood abuse and lifetime psychopathology in a community sample. Am J Psychiatry 2001; 158: 1878–83

  120. 120.

    Arnow BA, Hart S, Scott C, et al. Childhood sexual abuse, psychological distress, and medical use among women. Psychosom Med 1999; 61: 762–70

  121. 121.

    Felitti VJ, Anda RF, Nordenberg DF, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14: 248–58

  122. 122.

    Edwards VJ, Holden GW, Felitti VJ, et al. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the Adverse Childhood Experiences Study. Am J Psychiatry 2003; 160: 1453–60

  123. 123.

    Vythilingam M, Heim C, Newport J, et al. Childhood trauma associated with smaller hippocampal volume in women with major depression. Am J Psychiatry 2002; 159: 2072–80

  124. 124.

    Pribor EF, Yurzy SH, Dean JT, et al. Briquet’s syndrome, dissociation, and abuse. Am J Psychiatry 1993; 150: 1507–11

  125. 125.

    Barsky AJ, Wool C, Barnett MC, et al. Histories of childhood trauma in adult hypochondriacal patients. Am J Psychoanal 1994; 151: 397–401

  126. 126.

    Morrison J. Childhood sexual histories of women with somatization disorder. Am J Psychiatry 1989; 146: 239–41

  127. 127.

    Walker E, Katon WJ, Hanson J, et al. Psychiatric diagnoses and sexual victimization in women with chronic pelvic pain. Psychosomatics 1995; 36: 531–40

  128. 128.

    Blair JA, Blair RS, Rueckert P. Pre-injury emotional trauma and chronic back pain. Spine 1994; 19: 1144–7

  129. 129.

    Drossman DA. Physical and sexual abuse and gastrointestinal illness: what is the link? Am J Med 1994; 97: 105–7

  130. 130.

    Scarinci IC, McDonald-Haile J, Bradley LA, et al. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med 1994; 97: 108–18

  131. 131.

    Hudson JL, Pope Jr HG. Does childhood sexual abuse cause fibromyalgia? Arthritis Rheum 1995; 38: 161–3

  132. 132.

    Aaron LA, Bradley LA, Alarcon GS, et al. Perceived physical and emotional trauma as precipitating events in fibromyalgia: associations with health care and disability status but not pain severity. Arthritis Rheum 1997; 40: 453–60

  133. 133.

    Staudenmayer H, Selner ME, Selner JC. Adult sequelae of childhood abuse presenting as environmental illness. Ann Allergy 1993; 71: 538–46

  134. 134.

    Brown TM, Merritt WD, Evans DL. Psychogenic vocal cord dysfunction masquerading as asthma. J Nerv Ment Dis 1988; 176: 308–10

  135. 135.

    Freedman MR, Rosenberg SJ, Schmaling KB. Childhood sexual abuse in patients with paradoxical vocal cord dysfunction. J Nerv Ment Dis 1991; 179: 295–8

  136. 136.

    True WR, Rice J, Eisen SA, et al. A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. Arch Gen Psychiatry 1993; 50: 257–64

  137. 137.

    Stein MB, Jang KL, Taylor S, et al. Genetic and environmental influences of trauma exposure and posttraumatic stress disorder symptoms. Am J Psychiatry 2002; 159: 1675–81

  138. 138.

    Lyons MJ, Goldberg J, Eisen SA, et al. Do genes influence exposure to trauma: a twin study of combat. Am J Med Genet 1993; 48: 22–7

  139. 139.

    Koenen KC, Harley R, Lyons MJ, et al. A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. J Nerv Ment Dis 2002; 190: 209–18

  140. 140.

    Green BL, Grace MC, Lindy JD, et al. Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans. Am J Psychiatry 1990; 147: 729–33

  141. 141.

    Goldberg J, True WR, Eisen SA, et al. A twin study of the effects of the Vietnam War on posttraumatic stress disorder. JAMA 1990; 263: 1227–32

  142. 142.

    King DW, King LA, Foy D, et al. Posttraumatic stress disorder in a national sample of female and male Vietnam veterans; risk factors, war-zone Stressors, and resilience-recovery variables. J Abnorm Psychol 2000; 108: 164–70

  143. 143.

    Wolfe J, Erickson DJH, Sharkansky EJ, et al. Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis. J Consult Clin Psychol 2000; 67: 520–8

  144. 144.

    Prigerson HG, Maciejewski PK, Rosenheck RA. Combat trauma: trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men. J Nerv Ment Dis 2001; 189: 99–108

  145. 145.

    Bromet E, Sonnega A, Kessler RC. Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 1998; 147: 353–61

  146. 146.

    Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community. Arch Gen Psychiatry 1998; 55: 626–32

  147. 147.

    Creamer M, Burgess P, McFarlane AC. Posttraumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-Being. Psychol Med 2001; 31: 1237–47

  148. 148.

    Christenson RM, Walker JI, Ross DR, et al. Reactivation of traumatic conflicts. Am J Psychiatry 1981; 138: 984–5

  149. 149.

    Resnick HS, Yehuda R, Pitman RK, et al. Effect of previous trauma on acute plasma cortisol level following rape. Am J Psychiatry 1995; 152: 1675–7

  150. 150.

    Bremner JD, Vythilingam M, Vermetten E, et al. MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. Am J Psychiatry 2003; 160: 924–32

  151. 151.

    Frodl T, Meisenzahl EM, Zetzsche T, et al. Hippocampal changes in patients with a first episode of major depression. Am J Psychiatry 2002; 159: 1112–8

  152. 152.

    Shusterman D, Balmes J, Cone J. Behavioral sensitization to irritants/odorants after acute over exposures. J Occup Med 1988; 30: 565–7

  153. 153.

    Van den Bergh O, Stegen K, Van de Woestijne KP. Learning to have psychosomatic complaints: conditioning of respiratory behavior and somatic complaints in psychosomatic patients. Psychosom Med 1997; 59: 13–23

  154. 154.

    Van den Bergh O, Stegen K, Van Dest I, et al. Acquisition and extinction of somatic symptoms in response to odors: a Pavlovian paradigm relevant to multiple chemical sensitivity. Occup Environ Med 1999; 56: 295–301

  155. 155.

    Devriese S, Winters W, Stegen K, et al. Generalization of acquired somatic symptoms in response to odors: a Pavlovian perspective on multiple chemical sensitivity. Psychosom Med 2000; 62: 751–9

  156. 156.

    Rescorla RA. Pavlovian conditioning: it is not what you think it is. Am Psychol 1988; 43: 151–60

  157. 157.

    Staudenmayer H. Multiple chemical sensitivities or idiopathic environmental intolerances (EI): psychophysiological foundation of knowledge for a psychogenic explanation. J Allergy Clin Immunol 1997; 99: 434–7

  158. 158.

    Kandel ER, Hawkins RD. The biological basis of learning and individuality. Sci Am 1992 Sep; 267(3): 79–86

  159. 159.

    Stegen K, De Brunye K, Rasschaert W, et al. Fear-relevant images as conditioned stimuli for somatic complaints, respiratory behavior, and reduced end-tidal pCO2. J Abnorm Psychol 1999; 108: 143–52

  160. 160.

    Van den Bergh O, Devriese S, Winters W, et al. Acquiring symptoms in response to odors: a learning perspective on multiple chemical sensitivity. Ann N Y Acad Sci 2001; 933: 278–90

  161. 161.

    Jones TF, Graig AS, Hoy D, et al. Mass psychogenic illness attributed to toxic exposure at a high school. N Engl J Med 2000; 342: 96–100

  162. 162.

    Hodgson MJ, Frohliger J, Permar E, et al. Symptoms and microenvironmental measures in non-problem buildings. J Occup Med 1991; 33: 527–33

  163. 163.

    Cahill L, Prins B, Weber M, et al. Beta-adrenergic activation and memory for emotional events. Nature 1994; 371: 702–4

  164. 164.

    Kolb LC. Neurophysiological hypothesis explaining posttraumatic stress disorder. Am J Psychiatry 1987; 144: 989–95

  165. 165.

    Liotti M, Sava D, Rizzolatti G, et al. Differential hemispheric asymmetries in depression and anxiety: a reaction time study. Biol Psychiatry 1991; 29: 887–99

  166. 166.

    Cohen RA, O’Donnell BF. Physiological substrates of attention. In: Cohen RA, editor. The neuropsychology of attention. New York: Plenum, 1993: 115–44

  167. 167.

    Guidano VF, Liotti G. Cognitive processes and emotional disorders. New York: Guilford Press, 1983

  168. 168.

    Mayberg HS, Liotti M, Brannan SK, et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry 1999; 156: 675–82

  169. 169.

    Brewin CR, Andrews B, Gotlib IH. Psychopathology and early experience: a reappraisal of retrospective reports. Psychol Bull 1993; 113: 82–98

  170. 170.

    Halligan SL, Michael T, Clark M, et al. Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. J Consul Clin Psychol 2003; 71: 419–31

  171. 171.

    Van der Kolk BA. The body keeps score. In: van der Kolk BA, McFarlane AC, Weisaeth L, editors. Traumatic stress. New York: Guilford Press, 1996: 279–302

  172. 172.

    Terr LC. What happens to early memories of trauma. J Am Acad Child Adolescent Psychiatry 1988; 1: 96–104

  173. 173.

    Teicher MH, Ito Y, Glod CA, et al. Early abuse, limbic system dysfunction, and borderline personality disorder. In: Silk KR, editor. Biological and neurobehavioral studies of borderline personality disorder. Washington, DC: American Psychiatric Press, 1994: 177–207

  174. 174.

    Van der Kolk BA. The body keeps score: approaches to the psychobiology of posttraumatic stress disorder. In: van der Kolk B A, McFarlane AC, Weisaeth L, editors. Traumatic stress. New York: Guilford Press, 1996: 214–41

  175. 175.

    Shusterman D. Critical review: the health significance of environmental odor pollution. Arch Environ Health 1992; 47: 76–87

  176. 176.

    Shusterman D. Review of the upper airway, including olfaction, as mediator of symptoms. Environ Health Perspect 2002; 110Suppl. 4: 649–53

  177. 177.

    Shusterman D, Dager S. Prevention of psychological disability after occupational respiratory exposures. Occup Med 1991; 6: 11–27

  178. 178.

    Shusterman D, Lipscomb J, Neutra R, et al. Symptom prevalence and odor-worry interaction near hazardous waste sites. Environ Health Perspect 1991; 94: 25–30

  179. 179.

    Larkin M. Sniffing out memories of holidays past. Lancet 1999; 354: 2142

  180. 180.

    Van der Kolk BA. The trauma spectrum: the interaction of biological and social events in genesis of the trauma response. J Trauma Stress 1988; 1: 273–90

  181. 181.

    Chrousos GP, Gold PW. The concepts of stress and stress system disorders: overview of physical and behavioral homeostasis. JAMA 1992; 267: 1244–52

  182. 182.

    Sapolsky RM, Krey LC, McEwen BS. The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocr Rev 1986; 7: 284–301

  183. 183.

    Sapolsky RM. Stress, the aging brain, and the mechanisms of neuron death. Cambridge (MA): MIT Press, 1992

  184. 184.

    Sapolsky RM. Why stress is bad for your brain. Science 1996; 273: 749–50

  185. 185.

    Sapolsky RM. Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch Gen Psychiatry 2000; 57: 925–35

  186. 186.

    Rutter M. Psychopathology and development: I. childhood antecedents of adult psychiatric disorder. Aust N Z J Psychiatry 1984; 18: 225–34

  187. 187.

    Blanchard EB, Kolb LC, Pallmeyer TP, et al. A psychophysiological study of post traumatic stress disorder in Vietnam veterans. Psychiatr Q 1982; 54: 220–9

  188. 188.

    Pitman RK, Orr SP, Forgue DF, et al. Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry 1987; 44: 970–5

  189. 189.

    Lautenbacher S, Spernal J, Schreiber W, et al. Relationship between clinical pain complaints and pain sensitivity in patients with depression and panic disorder. Psychosom Med 1999; 61: 822–7

  190. 190.

    Clauw DJ, Chrousos GP. Chronic pain and fatigue syndromes: overlapping clinical an neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation 1997; 4: 134–53

  191. 191.

    Chrousos GP. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 1995; 332: 1351–62

  192. 192.

    Jewett DL. Diagnosis and treatment of hypersensitivity syndrome. Toxicol Ind Health 1992; 8: 111–23

  193. 193.

    Yehuda R. Stress and glucocorticoids. Science 1997; 275: 1662

  194. 194.

    Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50: 975–90

  195. 195.

    Bowlby J. The making and breaking of affectional bonds: aetiology and psychopathology in the light of attachment theory. Br J Psychiatry 1977; 130: 201–10

  196. 196.

    Schore AN. Affect regulation and the origin of the self: the neurobiology of emotional development. Englewood Cliffs (NJ): Lawrence Earlbaum, 1994

  197. 197.

    Krystal JH, Bennett AL, Bremner JD, et al. Toward a cognitive science of dissociation and altered mental function in posttraumatic stress disorder. In: Friedman MJ, Charney DS, Deutch AY, editors. Neurobiological and clinical consequences of stress: from normal adaptation to post-traumatic stress disorder. Hagerstown (MD): Lipincott-Raven, 1995: 239–69

  198. 198.

    Widom CS. Posttraumatic stress disorder in abused and neglected children grown up. Am J Psychiatry 1999; 156: 1223–9

  199. 199.

    Yehuda R, McFarlane AC, editors. Psychobiology of posttraumatic stress disorder. Ann N Y Acad Sci 1997, 821

  200. 200.

    Shors TJ. Stress and memory. In: Squire LR, editor. Encyclopedia of learning and memory. New York: Macmillan, 1992: 608–10

  201. 201.

    McEwen B, Sapolsky R. Stress and cognitive function. Curr Opin Neurobiol 1995; 5: 205–11

  202. 202.

    McEwen BS. Effects of adverse experiences for brain structure and function. Biol Psychiatry 2000; 48: 721–31

  203. 203.

    Hull AM. Neuroimaging findings in post-traumatic stress disorder. Br J Psychiatry 2002; 181: 102–10

  204. 204.

    Staudenmayer H. Psychological treatment of psychogenic idiopathic environmental intolerance (IEI). Occup Med 2000; 15: 627–46

  205. 205.

    Bolla KI. Neurobehavioral performance in multiple chemical sensitivities. Reg Toxicol Pharmacol 1996; 24: S52

  206. 206.

    Fiedler N, Kipen HM, Deluca J, et al. A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome. Psychosom Med 1996; 58: 38–49

  207. 207.

    Brown-DeGagne AM, McGlone J. Multiple chemical sensitivity: a test of the olfactory-limbic model. J Occup Environ Med 1999; 41: 366–77

  208. 208.

    Bolla KI. Use of neuropsychological testing in idiopathic environmental testing. Occup Med 2000; 15: 617–25

  209. 209.

    Lees-Haley PR, Brown RS. Biases in perception and reporting following a perceived toxic exposure. Perceptual Motor Skills 1992; 75: 531–44

  210. 210.

    Poonai NP, Antony MM, Binkley KE, et al. Psychological features of patients with idiopathic environmental intolerance. J Psychosom Res 2001; 51: 537–41

  211. 211.

    Stenn PG, Binkley K. Multiple chemical sensitivity. Psychosomatics 1998; 39: 393–4

  212. 212.

    Staudenmayer H, Kramer RE. Psychogenic chemical sensitivity: psychogenic pseudoseizures elicited by provocation challenges with fragrances. J Psychosom Res 1999; 47: 185–90

  213. 213.

    Haller E. Successful management of patients with ‘multiple chemical sensitivity’ on an inpatient psychiatric unit. J Clin Psychiatry 1993; 54: 196–9

  214. 214.

    Amundsen MA, Hanson NP, Bruce BK, et al. Odor aversion of multiple chemical sensitivities: recommendation for a name change and description of successful behavioral medicine treatment. Reg Toxicol Pharmacol 1996; 24: S116

  215. 215.

    Guglielmi RS, Cox DJ, Spyker DA. Behavioral treatment of phobic avoidance in multiple chemical sensitivity. J Behav Ther Exp Psychiatry 1994; 25: 197–209

  216. 216.

    Binkley KE, Stenn PG. ‘Specialized’ psychiatric referral: improved outcome in patients with multiple chemical sensitivity. J Allergy Clin Immunol 1998; 101 Suppl.: 587

  217. 217.

    Stenn P, Binkley K. Successful outcome in a patient with chemical sensitivity: treatment with psychological desensitization and selective serotonin reuptake inhibitor. Psychosomatics 1998; 39: 547–50

  218. 218.

    Hillert L, Kolmodin HB, Dolling BF, et al. Cognitive behavioral therapy for patients with electric sensitivity: a multidisciplinary approach in a controlled study. Psychother Psychosom 1998; 67: 302–10

  219. 219.

    Gomez R, Schvaneveldt RW, Staudenmayer H. Assessing beliefs about ‘environmental illness/multiple chemical sensitivity’. J Health Psychol 1996; 1: 107–23

  220. 220.

    Black DW, Sparks PJ. Psychiatric aspects of ‘chemical sensitivity’ syndromes. In: Stoudemire A, Vogel B, editors. Medical psychiatric practice. Vol. 3. Washington, DC: American Psychiatric Press, 1995: 347–80

  221. 221.

    Brodsky CM. ‘Allergic to everything’: a medical subculture. Psychosomatics 1983; 24: 731–42

  222. 222.

    Gupta K, Perharic L, Volans GN, et al. Apparent poisoning by wood preservatives: an attributional syndrome. J Psychosom Res 1997; 43: 391–8

  223. 223.

    Black DW. Iatrogenic (physician-induced) hypochondriasis: four patient examples of ‘chemical sensitivity’. Psychosomatics 1996; 37: 390–3

  224. 224.

    Black DW, Okiishi C, Schlosser S. A nine-year follow-up of people diagnosed with multiple chemical sensitivities. Psychosomatics 2000; 41: 253–61

  225. 225.

    Gibson PR, Elms AN, Ruding LA. Perceived treatment efficacy for conventional and alternative therapies reported by persons with multiple chemical sensitivity. Environ Health Perspect 2003; 111: 1498–504

  226. 226.

    Staudenmayer H. Clinical consequences of the EI/MCS ‘diagnosis’: two paths. Reg Toxicol Pharmacol 1996; 24: S96–S110

  227. 227.

    Bentall RP, Powell P, Nye FJ, et al. Predictors of response to treatment for chronic fatigue syndrome. Br J Psychiatry 2002; 181: 248–52

  228. 228.

    Busch FN, Cooper AM, Klerman GL, et al. Neurophysiological, cognitive-behavioral, and psychoanalytic approaches to panic disorder: toward an integration. Psychoanalytic Inquiry 1991; 11: 316–32

  229. 229.

    Shear MK, Cooper AM, Klerman GL, et al. A psychodynamic model of panic disorder. Am J Psychiatry 1993; 150: 859–66

  230. 230.

    Shear MK. Factors in the etiology and pathogenesis of panic disorder: revisiting the attachment-separation paradigm. Am J Psychiatry 1996; 153: 125–36

  231. 231.

    Shorter E. Multiple chemical sensitivity: pseudodisease in historical perspective. Scand J Work Environ Health 1997; 23Suppl. 3: 35–42

  232. 232.

    Ford CV. Somatization and fashionable diagnoses: illness as a way of life. Scand J Work Environ Health 1997; 23Suppl. 3: 7–16

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Acknowledgements

No funding was received to assist the preparation of this manuscript. The authors have no conflict of interest. We thank Su Dierbeck for secretarial assistance. We dedicate this work to the memory of our colleague, Neil L. Rosenberg, M.D.

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Correspondence to Herman Staudenmayer.

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Staudenmayer, H., Binkley, K.E., Leznoff, A. et al. Idiopathic Environmental Intolerance. Toxicol Rev 22, 247–261 (2003). https://doi.org/10.2165/00139709-200322040-00006

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Keywords

  • Childhood Sexual Abuse
  • Panic Disorder
  • Functional Somatic Syndrome
  • Emotional Trauma
  • Vocal Cord Dysfunction