Functional disorders--a cause of increasing work absence?

In this issue of Occupational Medicine, IIhlebaek et al. [1] report on health complaints and sickness absence. Against the backdrop of a 65% increase in sickness absence days over the 7 years to 2003 they discovered that the prevalence of health complaints, while high, had been stable over this period apart from allergy and asthma. Although the research is from a single Nordic country, it is likely that their findings are applicable throughout Western Europe. \udWhat might account for this apparent discrepancy? Despite conflicting trends perhaps there is a clue in another of their findings—that while their absolute numbers were relatively small, the largest increase in sickness absence was related to sleep problems, tiredness and anxiety symptoms. These are non-specific symptoms, common to each of us as individuals and certainly familiar to clinicians as a substantial part of their workload. These are also closely associated with the functional disorders. \udFunctional disorders are characterized by combinations of symptoms which can be associated with virtually any body system. Symptoms can be changeable, affecting different bodily systems and overlapping between one type of disorder and another. These disorders have no clear pathophysiological basis and are also not merely a surrogate ..