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Unformatted text preview: A Controlled Comparison of Multiple Chemical Sensitivities and Chronic Fatigue Syndrome NANCY FIEDLER, PHD, HOWARD M. KIPEN, MD, MPH, JOHN DELUCA, PHD, KATHIE KELLY-MCNEIL, BA, AND BENJAMIN NATELSON, MD The present study had two objectives: 1) to determine the characteristics that differentiated subjects with multiple chemical sensitivities (MCS), chemical sensitivities (CS), and chronic fatigue syndrome (CFS); and 2) to evaluate the psychiatric and neuropsychological complaints of these groups relative to normal controls. A cross-sectional comparison was made of the following groups matched for age, sex, and education: 1) patients whose sensitivities to multiple low level chemical exposures began with a defined exposure (MCS; N = 23); 2) patients with sensitivities to multiple chemicals without a clear date of onset (CS; N = 13); 3) patients meeting CDC criteria for Chronic Fatigue Syndrome (CFS; N = 18); and 4) normal controls (AT = 18). Subjects with sensitivities to chemicals (MCS and CS) reported significantly more lifestyle changes due to chemical sensitivities and significantly more chemical substances that made them ill compared with chronic fatigue and normal controls. MCS, CS, and CFS patients had significantly higher rates of current psychiatric disorders than normal controls and reported significantly more physical symptoms with no medical explanation. Seventy-four percent of MCS and 61% of CFS did not qualify for any current Axis I psychiatric diagnosis. Chemically sensitive subjects without a defined date of onset (CS) had the highest rate of Axis I psychiatric disorders (69%). On the MMPI-2, 44% of MCS, 42% of CS, 53% of CFS, and none of the controls achieved clinically significant elevations on scales associated with somatoform disorders. With the exception of one complex test of visual memory, no significant differences were noted among the groups on tests of neuropsychological function. Standardized measures of psychiatric and neuropsychological function did not differentiate subjects with sensitivities to chemicals from those with chronic fatigue. Subjects with sensitiv- ities to chemicals and no clear date of onset had the highest rate of psychiatric morbidity. Standardized neuropsychological tests did not substantiate the cognitive impairment reported symptomatically. Cognitive deficits may become apparent under controlled exposure conditions. Key words: chemical sensitivities, chronic fatigue, psychiatric, neuropsychiatric. INTRODUCTION In the last decade, chronic fatigue syndrome (CFS) and multiple chemical sensitivities (MCS) have re- ceived increasing attention in the medical literature. Because no consistent physical finding or laboratory abnormality has been discovered to account for the symptoms associated with these illnesses, they are regarded frequently as manifestations of psychiatric disorders such as depression, anxiety, and somatiza- tion disorder (1-3). The Centers for Disease Control From the UMDNJ-Robert Wood Johnson Medical School, Envi-...
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- Spring '08