The associated features of multiple somatic symptom complexes

Francis Creed, Barbara Tomenson, Carolyn A. Chew-Graham, Gary Macfarlane, John McBeth

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To assess whether two or more functional somatic symptom complexes (SSCs) showed stronger association with psychosocial correlates than single or no SSC after adjustment for depression/anxiety and general medical disorders.


In a population-based sample we identified, by standardised questionnaire, participants with chronic widespread pain, chronic fatigue and irritable bowel syndrome, excluding those with a medical cause for pain/fatigue. We compared psychosocial variables in three groups: multiple (>1), single or no FSS, adjusting for depression/anxiety and general medical disorders using ordinal logistic regression. We evaluated whether multiple SSCs predicted health status 1 year later using multiple regression to adjust for confounders.


Of 1443 participants (58.0% response) medical records were examined in 990: 4.4% (n=44) had 2 or 3 symptom complexes, 16.2% a single symptom complex. Most psychosocial adversities were significantly associated with number of SSCs in the expected direction but, for many, statistical significance was lost after adjustment for depression/anxiety and medical illness. Somatic symptoms, health anxiety, impairment and number of prior doctor visits remained significantly associated. Impaired health status 1 year later was predicted by multiple somatic symptom complexes even after adjustment for depression, anxiety, medical disorders and number of symptoms.


Depression, anxiety, medical illness and health anxiety , demonstrated an exposure-response relationship with number of somatic symptom complexes. These may be core features of all Functional Somatic Syndromes and may explain why number of somatic symptom complexes predicted subsequent health status. These features merit inclusion in prospective studies to ascertain causal relationships.
Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalJournal of Psychosomatic Research
Early online date12 Jun 2018
Publication statusPublished - Sep 2018


  • chronic fatigue
  • epidemiology
  • fibromyalgia
  • functional somatic syndromes
  • medically unexplained symptoms
  • population based


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