The committee wishes to emphasize that it is impressed with the dedication and concern exhibited by DoD personnel with whom committee members met. These individuals are knowledgeable regarding Persian Gulf issues and willing to learn more about identifying and resolving areas of concern for improving the health of active-duty personnel deployed to the Gulf.

MEDICALLY UNEXPLAINED SYMPTOM SYNDROMES

The committee spent some time deliberating on the precise meaning of "difficult to diagnose" or "ill defined" as a description of a category of conditions. When labeling something as difficult to diagnose, one usually means that special expertise is required to arrive at a diagnosis, but many of these conditions do not require such expertise. Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity are symptom complexes that have a great deal of overlap in the symptoms present in each condition but are well defined clinically, even if they are medically unexplained. Despite the fact that they are medically unexplained, they may cause significant impairment and they are illnesses that are only understood through time, that is, it requires the passage of time and the evaluation of responses to treatment to arrive at these diagnoses. The committee decided, therefore, to refer to this spectrum of illnesses as medically unexplained symptom syndromes.  This spectrum of illnesses may include those which are etiologically unexplained, lack currently detectable pathophysiological changes, and/or cannot currently be diagnostically labeled.

These medically unexplained symptom syndromes are often associated with depression and anxiety. There remains a debate about how to distinguish these syndromes from psychiatric diagnoses, but it is clear that they are not simply psychiatric diagnoses. However, since most of the recommended treatments for medically unexplained symptom syndromes overlap with the pharmacological and behavioral treatments for psychological conditions or psychiatric diagnoses, the committee believes that it is important to identify and evaluate the symptoms associated with these conditions and then treat those symptoms.

The committee recommends that when patients presenting with medically unexplained symptom syndromes are evaluated, the provider must have access to the full and complete medical record, including previous use of services. The presence of such information is important because adequate evaluation of these disorders involves a longitudinal perspective that includes response to treatment.

In the area of medically unexplained symptom syndromes, it is sometimes not possible to arrive at a definitive diagnosis. It may be possible, however, to treat the presenting complaints or symptoms. The committee recommends that in cases where a diagnosis cannot be identified, treatment should be



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