Subjective health complaints neurasthenia

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					Scandinavian Journal of Psychology, 2002, 43, 101–103




Subjective health complaints
Blackwell Science Ltd




HEGE R. ERIKSEN and CAMILLA IHLEBÆK
Department of Biological and Medical Psychology, University of Bergen, Norway



Eriksen, H. R. & Ihlebæk, C. (2002). Subjective health complaints. Scandinavian Journal of Psychology, 43, 101– 103.
A variety of subjective illnesses with few or no objective findings have appeared at regular intervals as epidemics in our society under different
labels. There are few or no objective findings that might explain the “disease” or the complaints go beyond what is regarded as “reasonable”
by the physician. Muscle pain and other types of subjective health complaints are among the most frequent reason for encounters with general
practitioners, and one of the major causes for sickness absence. The prevalence of subjective health complaints is very high, with at least 75%
of the population reporting one or more subjective health complaints the past 30 days. From a statistical point of view, it is “normal” to have
complaints. It is when they become intolerable that assistance is required. The difficult thing is that this threshold is individual and subjective.
The psychiatric definitions of these complaints, therefore, refer only to the tip of an iceberg.
Key words: subjective health complaints, musculoskeletal pain, gastrointestinal problems, low back pain, illness, unexplained symptoms.
Hege R. Eriksen, Department of Biological and Medical Psychology, University of Bergen, Aarstadveien 21, N-5009 Bergen, Norway. E-mail:
hege.eriksen@psych.uib.no


A variety of subjective illnesses with few or no objective                  Association, 1994). Several studies have reported high comorbi-
findings have appeared under different labels at regular inter-              dity of pain syndromes and depression (Croft, Rigby, Boswell,
vals as epidemics in our society. Examples are chronic fatigue              Schollum, & Silman, 1993; Værøy & Merskey, 1997). In some
syndrome, food intolerance, myalgic encephalitis, “yuppie                   cultures, it might be more acceptable to present somatic
flu”, fibromyalgia, post-viral syndrome, Gulf War syndrome,                   complaints rather than feelings of sadness or guilt. How-
etc. Patients diagnosed with these illnesses complain of muscle             ever, although there might be cultural differences in how to
pain, tiredness, depression, fatigue, headaches, sleep disturb-             communicate and experience symptoms, the essential and
ances, concentration problems, and memory lapses. There are,                dominating symptoms of depression, at least in Western
however, few or no objective findings that might explain the                 countries, are general sadness, hopelessness, and the feeling
“disease” or the complaints go beyond what is regarded as                   of being “down in the dumps” rather than subjective health
“reasonable” by the physician (Eriksen, Svendsrød, Ursin, &                 complaints in general. Still, some of the patients with subject-
Ursin, 1998). There is considerable ambiguity in the dia-                   ive health complaints may be depressed patients presenting
gnosis and treatment of this very large group of patients, or               with somatic complaints.
potential patients. It is likely that several of the “new” dis-                In their extreme form subjective complaints are referred
orders reported may be nothing more than erroneous labels                   to as somatization disorder under the somatoform disorders
or attributions for “normal” complaints, or lesser versions of              in DSM-IV. However, the criteria for this disorder are very
somatization disorder, or undifferentiated somatoform dis-                  strict and the lifetime prevalence of DSM-IV somatization
orders (American Psychiatric Association, 1994).                            disorder ranges from 0.2% to 2% for women and is less
   Muscle pain and other types of subjective health com-                    than 0.2% for men (American Psychiatric Association, 1994).
plaints without verifiable somatic disease are reported among                Therefore, DSM-IV somatization disorder appears to catch
at least 75% of the normal population (Eriksen et al., 1998),               only the tip of the iceberg of subjective health complaints.
and account for as much as 50% of long-term sickness                        The majority of individuals with subjective health com-
compensation and permanent disability in Norway (Tellnes,                   plaints have complaints that do not reach the required
Svendsen, Bruusgaard, & Bjerkedal, 1989). However, in spite                 thresholds for these disorders, and are considered as having
of the high prevalence, and the high impact on social security              “normal” complaints, or given a host of attributions and
services, there is no consensus as to diagnoses or criteria for             labels. There seems to be no clear cut-off point in the distri-
granting sickness certification (Haldorsen, Brage, Johannessen,              bution of subjective health complaints that could help to
Tellnes, & Ursin, 1996).                                                    differentiate between “normal” complaints on the one hand,
   Subjective health complaints should always be examined                   and intolerable complaints that need professional help on
carefully to rule out the possibility that they are early mani-             the other (Ihlebæk, Eriksen & Ursin, in press). The interpreta-
festations of pathological, organic diseases. There are also                tion of a given complaint is probably highly influenced by
major symptom overlaps with depressive disorders. Insomnia,                 personal concepts.
tiredness, fatigue, bodily aches and pains are all listed in the               Experience from epidemic fatigue (Wessely, 1990) and
DSM-IV diagnostic system of mental disorders as possible                    whiplash neck injuries (Bovim, Schrader, & Sand, 1994)
criteria for a major depressive episode (American Psychiatric               suggests that knowledge of the prevalence of subjective

© 2002 The Scandinavian Psychological Associations. Published by Blackwell Publishers, 108 Cowley Road, Oxford OX4 1JF, UK and
350 Main Street, Malden, MA 02148, USA. ISSN 0036-5564.
102   H. R. Eriksen and C. Ihlebæk                                                                           Scand J Psychol 43 (2002)

complaints might be useful in evaluating new “epidemics” of       more common in younger individuals (Eriksen et al., 1998;
vague complaints. Are these complaints really new diseases,       Ihlebæk et al., in press).
or just new labels and attributions for “old wine in new             After a temporary decrease from 1989 to 1994, sickness
bottles” (Wessely, 1990)? The earliest descriptions of such       absence and permanent disability are now increasing in
conditions date back at least 4,000 years (Ford, 1997). The       Norway (National Insurance Administration, 1998, 1999).
term “hysteria” was widely used to describe conditions for        However, the prevalence data for single complaints from
which there was no organic basis. The common view was             the Nordic countries in 1993 compare very well with the
that hysteria was peculiar to women, and was caused by dis-       Norwegian data from 1996–8. This suggests that the preval-
turbances of the uterus. In 1859, Briquet described hysteria      ence of complaints is stable, despite the increase in sickness
as “a neurosis of the brain in which the observed phenomena       leave. The increase in sickness absence, therefore, does not
consist chiefly as a perturbation of vital activities that serve   seem to indicate any major change in the subjective health,
as the manifestations of affective feelings and passions”. He     or subjective health complaints.
also found that it does exist in men. This seems to be a             From a statistical point of view, it is “normal” to have one
surprise to men, and keeps on being rediscovered, for example     or even several complaints, since most people do have them.
by Freud, and in a late report from 1991 (Golding, Smith          It is when they become intolerable that assistance is required.
& Kashner, 1991). In 1869, in the US, Beard described             The difficult thing is that this threshold is individual and
asthenia, or Beard’s disease, as a syndrome consisting of         subjective. The psychiatric definitions of these complaints,
tiredness and multiple complaints (Chatel & Peele, 1970).         therefore, refer only to the tip of the iceberg.
Beard believed it to be caused by strong emotions causing
an exhaustion of the nervous system. Neurasthenia and psy-        The authors have been supported by the Ministry of Health and Social
                                                                  Affairs, and the Norwegian Research Council.
chasthenia, terms related to asthenia, became very popular
around 1900, and Pavlov even used it for some of his dogs
(Ursin, 1997). Neurasthenia has been suggested as a term          REFERENCES
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© 2002 The Scandinavian Psychological Associations.
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© 2002 The Scandinavian Psychological Associations.