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In addition to testimony from veterans' groups, patients, and their families regarding problems they have encountered (see Appendix B for details), the committee reviewed published studies that examined symptoms and conditions reported in Gulf War veterans. Symptom reports from 10 surveys are displayed in Table 2-1. Other symptoms reported include back pain, wheezing, swelling in joints, loss of strength, blurred vision, sensitivity to chemicals, slow healing, impotence, painful intercourse, and burning semen.

Most Gulf War veterans experiencing one or more of these symptoms have readily identifiable medical conditions. However, about 20% of symptomatic veterans examined in the VA and DoD registries report multiple symptoms for which no readily identifiable diagnosis exists. Symptoms reported correspond closely to symptoms experienced by people in other than veteran populations who have recognized diagnoses of unknown etiology. Symptoms experienced by Gulf War veterans have a significant degree of overlap with symptoms of patients diagnosed with these conditions, such as fibromyalgia (joint pain, sleep disturbances, fatigue), chronic fatigue syndrome (fatigue, headache, cognitive dysfunction), depression (fatigue, loss of memory and other general symptoms, cognitive dysfunction, and sleep disturbances), and irritable bowel syndrome (diarrhea and other gastrointestinal symptoms, abdominal pain, nausea, and vomiting).

The committee decided that it would examine treatments for these recognized diagnoses of unknown etiology to determine what might be learned and borrowed from these conditions to apply to the treatment of Gulf War veterans. Headache and panic disorder were included in the report because they also involve symptoms similar to those reported by Gulf War veterans. Posttraumatic stress disorder (PTSD) was included because of its increased prevalence in this as well as other veteran populations. 1

There are also a number of patients who experience symptoms that do not fall into these defined diagnostic categories. The committee considered two alternative approaches to evaluating treatments for patients with unexplained symptoms: (1) the dimensional approach and (2) the categorical approach.

The dimensional approach posits that a substantial overlap exists between the individual syndromes; that is, unexplained illness occurs on a continuum of the population extending from individuals with symptoms to those without symptoms and the similarities between conditions out

1 The committee acknowledges the VA's expertise in the treatment of PTSD but includes the diagnosis here for the sake of completeness.

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