Bailer Josef, Witthöft Michael, Rist Fred
Department of Clinical Psychology, Central Institute of Mental Health, Mannheim, Germany.
J Toxicol Environ Health A. 2008;71(11-12):766-75. doi: 10.1080/15287390801985562.
Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity (MCS), is defined as a chronic polysymptomatic condition that cannot be explained by an organic disease. Previous studies suggest that IEI may be a variant of somatoform disorders (SFD), because both disorders overlap with respect to symptoms and psychological features of somatization. However, little is known about the short- and medium-term outcome of IEI and psychological outcome predictors. Two clinical groups (IEI and SFD) and a comparison group (CG) were followed through 32 mo to assess both the outcome, and the extent to which trait anxiety and somatic symptom attribution (assessed at first examination) predict outcome presented 12 and 32 mo later. Outcome measures were the number of self-reported IEI symptoms, IEI triggers, IEI-associated functional impairments, and the number of somatoform symptoms. In addition, the course of the 2 syndromes over the 32-mo follow-up period was investigated with standardized screening scales. The 3 diagnostic groups consisted of 46 subjects with IEI, 38 subjects with SFD but without IEI, and 46 subjects (CG) with neither IEI nor SFD. Syndrome stability was high over the 32-mo follow-up period, and at both follow-ups IEI and non-IEI subjects differed on all IEI outcome measures (symptoms, triggers, functional impairments). Both trait anxiety and somatic attribution (the tendency to attribute common somatic complaints to an illness) predicted outcome. In addition, somatic attribution was found to partially mediate the effect of trait anxiety on outcome in the IEI group. In conclusion, these results suggest that IEI is a chronic and disabling condition and that trait anxiety contributes to the maintenance of the disorder via somatic attributions.
特发性环境不耐受（IEI），也称为多重化学物质敏感（MCS），被定义为一种无法用器质性疾病解释的慢性多症状疾病。先前的研究表明，IEI可能是躯体形式障碍（SFD）的一种变体，因为这两种疾病在症状和躯体化的心理特征方面存在重叠。然而，关于IEI的短期和中期结果以及心理结果预测因素知之甚少。对两个临床组（IEI和SFD）和一个对照组（CG）进行了32个月的随访，以评估结果，以及特质焦虑和躯体症状归因（在首次检查时评估）在12个月和32个月后预测结果的程度。结果测量指标包括自我报告的IEI症状数量、IEI触发因素、IEI相关功能损害以及躯体形式症状数量。此外，使用标准化筛查量表调查了这两种综合征在32个月随访期内的病程。这3个诊断组包括46名患有IEI的受试者、38名患有SFD但无IEI的受试者以及46名既无IEI也无SFD的受试者（CG）。在32个月的随访期内，综合征稳定性较高，在两次随访中，IEI组和非IEI组在所有IEI结果测量指标（症状、触发因素、功能损害）上均存在差异。特质焦虑和躯体归因（将常见躯体不适归因于疾病的倾向）均能预测结果。此外，在IEI组中发现躯体归因部分介导了特质焦虑对结果的影响。总之，这些结果表明，IEI是一种慢性致残性疾病，特质焦虑通过躯体归因促成了该疾病的持续存在。
